| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $45.60 | $45.60 | $45.60 | |
Aetna
| Professional | $45.60 | $45.60 | $45.60 | |
Cigna
| Facility | $70.00 | $70.00 | $70.00 | |
Medcost
| Facility | $45.60 | $45.60 | $61.56 | |
Medcost
| Professional | $57.00 | $57.00 | $57.00 | |
Molina
| Professional | $30.00 | $30.00 | $30.00 |