| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $71.52 | $71.52 | $223.14 | |
Aetna
| Professional | $71.52 | $71.52 | $71.52 | |
Cigna
| Professional | $75.98 | $75.98 | $75.98 | |
Health Alliance Plan
| Facility | $71.52 | $89.40 | $199.00 | |
Health Alliance Plan
| Professional | $71.52 | $78.97 | $94.76 | |
United
| Professional | $74.50 | $74.50 | $79.04 |