| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $19.50 | $19.50 | $19.50 | |
Aetna
| Professional | $16.84 | $19.50 | $19.73 | |
Cigna
| Facility | $85.00 | $85.00 | $85.00 | |
Cigna
| Professional | $11.05 | $11.05 | $30.20 | |
Medcost
| Facility | $13.30 | $19.50 | $33.15 | |
Medcost
| Professional | $13.30 | $13.30 | $13.30 | |
Molina
| Professional | $30.00 | $30.00 | $30.00 |