| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $30.06 | $30.06 | $30.06 | |
Aetna
| Professional | $21.20 | $30.06 | $65.53 | |
Cigna
| Professional | $16.70 | $16.70 | $20.00 | |
Health Alliance Plan
| Facility | $30.06 | $106.92 | $106.92 | |
Health Alliance Plan
| Professional | $30.06 | $106.92 | $111.57 | |
United
| Professional | $64.73 | $105.81 | $145.97 |