| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $64.00 | $64.00 | $82.45 | |
Cigna
| Professional | $70.08 | $70.08 | $70.08 | |
Medcost
| Facility | $60.30 | $60.30 | $60.30 | |
Medcost
| Professional | $15.00 | $15.00 | $15.00 | |
Molina
| Professional | $30.00 | $30.00 | $30.00 |