| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $407.38 | $407.38 | $446.68 | |
Cigna
| Professional | $104.71 | $104.71 | $104.71 | |
Medcost
| Facility | $407.38 | $407.38 | $588.84 | |
Molina
| Professional | $30.20 | $30.20 | $30.20 |