| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $87.57 | $87.57 | $87.57 | |
Aetna
| Professional | $87.57 | $87.57 | $400.00 | |
Cigna
| Professional | $105.60 | $105.60 | $105.60 | |
Health Alliance Plan
| Facility | $87.57 | $87.57 | $87.57 | |
Health Alliance Plan
| Professional | $87.57 | $87.57 | $400.00 | |
Molina
| Professional | $30.00 | $30.00 | $55.00 | |
United
| Professional | $367.00 | $367.00 | $367.00 |