| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $0.30 | $0.30 | $0.30 | |
Aetna
| Professional | $0.30 | $0.30 | $0.30 | |
Cigna
| Professional | $2.71 | $2.71 | $2.71 | |
Health Alliance Plan
| Facility | $0.30 | $0.30 | $0.30 | |
Health Alliance Plan
| Professional | $0.30 | $0.30 | $0.30 | |
Molina
| Professional | $30.00 | $30.00 | $75.00 |