| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $25.47 | $25.47 | $25.47 | |
Aetna
| Professional | $25.47 | $25.47 | $43.54 | |
Health Alliance Plan
| Professional | $25.47 | $25.47 | $39.61 | |
Molina
| Professional | $30.00 | $80.98 | $1,500.00 |