| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $64.57 | $64.57 | $64.57 | |
Cigna
| Professional | $27.54 | $27.54 | $27.54 | |
Molina
| Professional | $32.36 | $33.11 | $50.12 | |
Pacific Source
| Facility | $28.18 | $37.15 | $40.74 | |
Pacific Source
| Professional | $34.67 | $34.67 | $34.67 |