| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $20.89 | $20.89 | $20.89 | |
Aetna
| Professional | $18.05 | $20.89 | $21.15 | |
Cigna
| Facility | $85.00 | $85.00 | $85.00 | |
Cigna
| Professional | $11.90 | $11.90 | $32.36 | |
Medcost
| Facility | $14.25 | $20.89 | $35.51 | |
Medcost
| Professional | $14.25 | $14.25 | $14.25 | |
Molina
| Professional | $30.00 | $30.00 | $30.00 |