| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $23.17 | $23.17 | $23.17 | |
Cigna
| Professional | $16.39 | $16.39 | $99.00 | |
Medcost
| Facility | $23.17 | $23.17 | $27.80 | |
Medcost
| Professional | $3.13 | $3.13 | $3.13 | |
Molina
| Professional | $30.00 | $30.00 | $55.00 |