| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $34.49 | $34.49 | $34.49 | |
Aetna
| Professional | $31.66 | $34.49 | $34.49 | |
Cigna
| Professional | $2.02 | $2.02 | $2.02 | |
Health Alliance Plan
| Facility | $34.49 | $34.49 | $34.49 | |
Health Alliance Plan
| Professional | $34.49 | $34.49 | $34.49 | |
Molina
| Professional | $30.00 | $30.00 | $1,500.00 |