| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $47.20 | $69.00 | $69.00 | |
Cigna
| Professional | $90.00 | $90.00 | $90.00 | |
Health Alliance Plan
| Facility | $70.00 | $71.14 | $81.81 | |
Health Alliance Plan
| Professional | $70.00 | $71.14 | $81.81 | |
Molina
| Professional | $30.00 | $30.00 | $55.00 |