| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $20.00 | $20.00 | $20.00 | |
Aetna
| Professional | $20.00 | $20.00 | $22.00 | |
Cigna
| Professional | $117.89 | $117.89 | $117.89 | |
Moda Health
| Facility | $20.00 | $20.00 | $21.20 | |
Molina
| Professional | $30.00 | $30.00 | $55.00 |