| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $103.02 | $103.02 | $104.03 | |
Aetna
| Professional | $48.00 | $93.93 | $104.03 | |
Cigna
| Professional | $45.92 | $45.92 | $118.46 | |
Health Alliance Plan
| Facility | $103.02 | $103.02 | $103.02 | |
Health Alliance Plan
| Professional | $50.14 | $103.02 | $131.30 | |
Molina
| Professional | $30.00 | $30.00 | $55.00 | |
United
| Professional | $54.00 | $68.67 | $99.00 |