| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $0.12 | $0.12 | $0.12 | |
Aetna
| Professional | $0.12 | $0.12 | $13.06 | |
Health Alliance Plan
| Facility | $0.12 | $0.12 | $0.12 | |
Health Alliance Plan
| Professional | $0.12 | $0.12 | $12.00 | |
Molina
| Professional | $30.00 | $100.00 | $1,500.00 |