| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $450.00 | $450.00 | $450.00 | |
Aetna
| Professional | $450.00 | $450.00 | $450.00 | |
Cigna
| Facility | $64.00 | $64.00 | $64.00 | |
Cigna
| Professional | $258.52 | $258.52 | $258.52 | |
Medcost
| Facility | $54.00 | $495.00 | $952.18 | |
Molina
| Professional | $30.00 | $30.00 | $30.00 |