| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $70.79 | $70.79 | $70.79 | |
Aetna
| Professional | $70.79 | $70.79 | $70.79 | |
Cigna
| Professional | $51.29 | $51.29 | $51.29 | |
Medcost
| Facility | $70.79 | $74.13 | $120.23 | |
Molina
| Professional | $30.20 | $30.20 | $30.20 |