| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $19.67 | $19.67 | $19.67 | |
Aetna
| Professional | $19.67 | $19.67 | $19.67 | |
Cigna
| Facility | $64.00 | $64.00 | $64.00 | |
Cigna
| Professional | $14.11 | $14.11 | $14.11 | |
Molina
| Professional | $40.00 | $40.00 | $50.00 | |
Wellpoint
| Professional | $11.40 | $11.40 | $11.40 |