| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $103.00 | $106.00 | $106.00 | |
Cigna
| Professional | $29.00 | $29.00 | $29.00 | |
Health Alliance Plan
| Professional | $0.04 | $0.04 | $103.00 | |
Molina
| Professional | $30.00 | $30.00 | $30.00 |