| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $422.82 | $422.82 | $422.82 | |
Cigna
| Professional | $322.00 | $322.00 | $322.00 | |
Health Alliance Plan
| Facility | $290.72 | $290.72 | $422.82 | |
Health Alliance Plan
| Professional | $7.42 | $7.42 | $7.42 | |
Molina
| Professional | $30.00 | $30.00 | $55.00 |