| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $16.98 | $16.98 | $16.98 | |
Aetna
| Professional | $16.98 | $16.98 | $18.20 | |
Cigna
| Facility | $18.20 | $18.20 | $18.20 | |
Cigna
| Professional | $18.20 | $18.20 | $18.20 | |
Medcost
| Facility | $17.78 | $19.50 | $30.20 | |
Molina
| Professional | $30.20 | $30.20 | $30.20 |