| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $16.88 | $16.88 | $16.88 | |
Aetna
| Professional | $16.48 | $16.88 | $17.48 | |
Cigna
| Facility | $17.29 | $17.29 | $17.29 | |
Cigna
| Professional | $17.29 | $17.29 | $17.29 | |
Molina
| Professional | $16.95 | $16.95 | $75.00 |