| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $29.75 | $29.75 | $29.75 | |
Aetna
| Professional | $10.59 | $10.59 | $10.59 | |
Cigna
| Professional | $4.83 | $4.83 | $40.00 | |
Medcost
| Facility | $8.00 | $10.59 | $12.71 | |
Medcost
| Professional | $8.00 | $8.00 | $8.00 | |
Molina
| Professional | $30.00 | $30.00 | $55.00 |