| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $21.24 | $21.24 | $21.24 | |
Cigna
| Professional | $228.00 | $228.00 | $228.00 | |
Medcost
| Facility | $21.24 | $21.24 | $25.49 | |
Medcost
| Professional | $5.23 | $5.23 | $5.23 | |
Molina
| Professional | $30.00 | $30.00 | $55.00 |