| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $406.02 | $429.48 | $441.16 | |
Cigna
| Facility | $64.00 | $64.00 | $64.00 | |
Cigna
| Professional | $88.76 | $88.76 | $88.76 | |
Medcost
| Facility | $429.48 | $433.31 | $721.53 | |
Molina
| Professional | $30.00 | $30.00 | $30.00 |