| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $13.31 | $13.31 | $41.53 | |
Aetna
| Professional | $13.31 | $13.31 | $13.31 | |
Cigna
| Professional | $18.23 | $18.23 | $18.23 | |
Health Alliance Plan
| Facility | $1.06 | $23.29 | $41.53 | |
Health Alliance Plan
| Professional | $1.06 | $1.27 | $13.31 | |
Molina
| Professional | $30.00 | $30.00 | $30.00 |