| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $105.00 | $105.00 | $105.00 | |
Aetna
| Professional | $30.85 | $30.85 | $30.85 | |
Cigna
| Professional | $130.13 | $130.13 | $130.13 | |
Medcost
| Facility | $8.00 | $30.85 | $37.02 | |
Medcost
| Professional | $8.00 | $8.00 | $8.00 | |
Molina
| Professional | $30.00 | $30.00 | $55.00 |