| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $5.00 | $5.00 | $5.00 | |
Aetna
| Professional | $5.00 | $5.00 | $5.00 | |
Cigna
| Facility | $42.79 | $42.79 | $70.15 | |
Cigna
| Professional | $31.24 | $31.24 | $31.24 | |
Medcost
| Facility | $5.00 | $5.75 | $10.58 | |
Molina
| Professional | $30.00 | $30.00 | $30.00 |