| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $4.05 | $18.41 | $18.41 | |
Aetna
| Professional | $4.05 | $18.41 | $18.41 | |
Cigna
| Facility | $64.00 | $64.00 | $64.00 | |
Molina
| Professional | $40.00 | $40.00 | $50.00 | |
Wellpoint
| Professional | $4.50 | $4.50 | $4.50 |