| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2.02 | $2.02 | $2.02 | |
Aetna
| Professional | $2.02 | $2.02 | $2.02 | |
Cigna
| Facility | $128.59 | $128.59 | $163.02 | |
Cigna
| Professional | $93.87 | $93.87 | $93.87 | |
Medcost
| Facility | $2.02 | $2.33 | $4.30 | |
Molina
| Professional | $30.00 | $30.00 | $30.00 |