| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $826.50 | $826.50 | $826.50 | |
Cigna
| Facility | $64.00 | $64.00 | $64.00 | |
Cigna
| Professional | $54.28 | $54.28 | $54.28 | |
Medcost
| Facility | $826.50 | $826.50 | $1,405.05 | |
Molina
| Professional | $30.00 | $30.00 | $30.00 |