| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $100.66 | $149.61 | $172.38 | |
Cigna
| Professional | $173.25 | $216.56 | $304.54 | |
Health Alliance Plan
| Facility | $153.60 | $153.60 | $153.60 | |
Health Alliance Plan
| Professional | $149.61 | $153.60 | $192.00 |