| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $19.27 | $19.27 | $19.27 | |
Aetna
| Professional | $9.00 | $19.27 | $19.27 | |
Cigna
| Professional | $141.00 | $141.00 | $176.25 | |
Health Alliance Plan
| Professional | $19.27 | $19.27 | $29.97 | |
Molina
| Professional | $30.00 | $30.00 | $1,500.00 |