| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $67.15 | $67.15 | $67.15 | |
Cigna
| Facility | $30.72 | $30.72 | $46.35 | |
Cigna
| Professional | $26.11 | $30.72 | $30.72 | |
Medcost
| Facility | $67.15 | $67.15 | $173.57 | |
Medcost
| Professional | $80.83 | $80.83 | $80.83 | |
Molina
| Professional | $30.00 | $30.00 | $70.00 |