| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $20.00 | $20.00 | $20.00 | |
Aetna
| Professional | $20.00 | $20.00 | $20.00 | |
BCBS
| Professional | $17.79 | $17.79 | $17.79 | |
Cigna
| Professional | $28.91 | $28.91 | $28.91 | |
Molina
| Professional | $20.00 | $20.00 | $30.00 |