| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $25.00 | $25.00 | $25.00 | |
Aetna
| Professional | $25.00 | $25.00 | $25.00 | |
Anthem BCBS
| Professional | $38.25 | $45.00 | $76.50 | |
Cigna
| Professional | $40.95 | $40.95 | $40.95 | |
Molina
| Professional | $50.00 | $50.00 | $50.00 |