| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $104.71 | $104.71 | $104.71 | |
Aetna
| Professional | $104.71 | $104.71 | $104.71 | |
BCBS
| Facility | $77.62 | $77.62 | $85.11 | |
Cigna
| Professional | $61.66 | $61.66 | $61.66 | |
Molina
| Professional | $30.20 | $30.20 | $30.20 |