| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $122.42 | $122.42 | $122.42 | |
Aetna
| Professional | $99.11 | $122.42 | $122.42 | |
Ambetter
| Professional | $74.97 | $112.80 | $148.66 | |
Cigna
| Professional | $9.85 | $9.85 | $9.85 | |
Health Alliance Plan
| Facility | $122.42 | $122.42 | $122.42 | |
Health Alliance Plan
| Professional | $99.11 | $122.42 | $221.65 | |
Molina
| Professional | $30.00 | $30.00 | $55.00 |