| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $27.78 | $27.78 | $27.78 | |
Aetna
| Professional | $27.78 | $27.78 | $65.91 | |
Cigna
| Professional | $36.96 | $36.96 | $36.96 | |
Health Alliance Plan
| Facility | $27.78 | $27.78 | $27.78 | |
Health Alliance Plan
| Professional | $27.78 | $27.78 | $37.52 | |
Molina
| Professional | $30.00 | $30.00 | $100.00 |