| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $15.49 | $30.90 | $37.15 | |
Health Alliance Plan
| Facility | $707.95 | $1,862.09 | $2,089.30 | |
Health Alliance Plan
| Professional | $676.08 | $776.25 | $954.99 | |
Priority Health
| Professional | $15.49 | $30.90 | $30.90 | |
United
| Facility | $691.83 | $691.83 | $691.83 | |
United
| Professional | $8.51 | $10.00 | $14.13 |