| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $78.75 | $78.75 | $78.75 | |
Aetna
| Professional | $24.46 | $24.46 | $24.46 | |
Cigna
| Professional | $58.98 | $58.98 | $120.00 | |
Medcost
| Facility | $8.00 | $24.46 | $29.35 | |
Medcost
| Professional | $8.00 | $8.00 | $8.00 | |
Molina
| Professional | $30.00 | $30.00 | $55.00 |