| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $67.15 | $67.15 | $67.15 | |
Aetna
| Professional | $58.88 | $67.15 | $95.62 | |
Cigna
| Facility | $30.72 | $30.72 | $30.72 | |
Cigna
| Professional | $30.72 | $30.72 | $869.25 | |
Health Alliance Plan
| Professional | $67.15 | $67.15 | $67.15 | |
Molina
| Professional | $30.00 | $30.00 | $50.00 |