| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $107.15 | $107.15 | $107.15 | |
Aetna
| Professional | $89.13 | $109.65 | $112.20 | |
Cigna
| Facility | $112.20 | $112.20 | $112.20 | |
Cigna
| Professional | $112.20 | $112.20 | $112.20 | |
Medcost
| Facility | $104.71 | $112.20 | $181.97 | |
Molina
| Professional | $30.20 | $30.20 | $30.20 |