| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $22.16 | $22.16 | $22.16 | |
Aetna
| Professional | $8.00 | $22.16 | $22.16 | |
Cigna
| Professional | $113.63 | $113.63 | $142.03 | |
Health Alliance Plan
| Professional | $22.16 | $22.16 | $34.47 | |
Molina
| Professional | $30.00 | $30.00 | $1,500.00 |