| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $5.66 | $5.66 | $5.66 | |
Aetna
| Professional | $5.66 | $5.66 | $13.94 | |
Cigna
| Facility | $64.00 | $64.00 | $64.00 | |
Medcost
| Facility | $5.66 | $6.79 | $12.68 | |
Molina
| Professional | $30.00 | $30.00 | $30.00 |