| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $19.05 | $19.05 | $19.05 | |
Aetna
| Professional | $15.85 | $19.05 | $19.95 | |
Cigna
| Facility | $85.11 | $85.11 | $85.11 | |
Cigna
| Professional | $107.15 | $107.15 | $107.15 | |
Medcost
| Facility | $19.05 | $20.89 | $33.11 | |
Molina
| Professional | $30.20 | $30.20 | $30.20 |