| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $68.13 | $68.13 | $68.13 | |
Aetna
| Professional | $68.13 | $68.13 | $91.87 | |
Cigna
| Professional | $35.29 | $35.29 | $35.29 | |
Health Alliance Plan
| Facility | $68.13 | $68.13 | $68.13 | |
Health Alliance Plan
| Professional | $68.13 | $68.13 | $68.13 |