| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $23.15 | $71.75 | $156.41 | |
Aetna
| Professional | $5.00 | $23.15 | $23.15 | |
Cigna
| Professional | $50.59 | $50.59 | $50.59 | |
Medcost
| Facility | $23.15 | $23.15 | $30.10 | |
Medcost
| Professional | $2.98 | $2.98 | $2.98 | |
Molina
| Professional | $30.00 | $30.00 | $30.00 |