| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $97.72 | $97.72 | $97.72 | |
Aetna
| Professional | $79.43 | $97.72 | $97.72 | |
Cigna
| Facility | $95.50 | $95.50 | $95.50 | |
Cigna
| Professional | $69.18 | $69.18 | $95.50 | |
Medcost
| Facility | $97.72 | $97.72 | $165.96 | |
Molina
| Professional | $30.20 | $30.20 | $30.20 |