| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $8.07 | $8.07 | $8.07 | |
Aetna
| Professional | $6.58 | $8.07 | $21.46 | |
Health Alliance Plan
| Facility | $8.07 | $8.07 | $8.07 | |
Health Alliance Plan
| Professional | $6.35 | $8.07 | $8.52 | |
Molina
| Professional | $30.00 | $30.00 | $1,500.00 |