| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $17.66 | $17.66 | $17.66 | |
Aetna
| Professional | $17.66 | $17.66 | $48.00 | |
BCBS
| Professional | $53.05 | $53.05 | $53.05 | |
Cigna
| Professional | $19.50 | $19.50 | $19.50 | |
Molina
| Professional | $17.00 | $21.25 | $50.00 |