| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $20.74 | $20.74 | $20.74 | |
Aetna
| Professional | $18.01 | $20.74 | $21.94 | |
Cigna
| Professional | $20.72 | $21.41 | $21.88 | |
Health Alliance Plan
| Facility | $20.74 | $20.74 | $20.74 | |
Health Alliance Plan
| Professional | $18.01 | $20.74 | $22.51 | |
Molina
| Professional | $30.00 | $30.00 | $55.00 |