| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $3.44 | $3.44 | $3.44 | |
Aetna
| Professional | $3.44 | $3.44 | $125.79 | |
Cigna
| Professional | $119.56 | $119.56 | $119.56 | |
Health Alliance Plan
| Facility | $3.44 | $3.44 | $3.44 | |
Health Alliance Plan
| Professional | $3.44 | $3.44 | $3.44 | |
Molina
| Professional | $30.00 | $30.00 | $100.00 | |
United
| Facility | $58.15 | $133.30 | $224.54 |