| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $3.75 | $3.75 | $3.75 | |
CareSource
| Facility | $14.04 | $21.60 | $21.60 | |
Cigna
| Facility | $68.36 | $68.36 | $68.36 | |
Cigna
| Professional | $58.51 | $58.51 | $58.51 | |
Molina
| Professional | $45.00 | $45.00 | $45.00 |