| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $68.13 | $68.13 | $68.13 | |
Aetna
| Professional | $68.13 | $68.13 | $88.72 | |
Cigna
| Facility | $69.23 | $69.23 | $69.23 | |
Cigna
| Professional | $35.29 | $35.29 | $35.29 | |
Medcost
| Facility | $59.73 | $68.13 | $91.98 | |
Molina
| Professional | $30.00 | $190.44 | $190.44 |