| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $19.27 | $19.27 | $19.27 | |
Cigna
| Professional | $68.79 | $68.79 | $68.79 | |
Medcost
| Facility | $19.27 | $19.27 | $23.12 | |
Medcost
| Professional | $9.39 | $9.39 | $9.39 | |
Molina
| Professional | $30.00 | $30.00 | $55.00 |