| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $355.88 | $355.88 | $377.23 | |
Cigna
| Professional | $408.00 | $408.00 | $492.28 | |
Health Alliance Plan
| Facility | $355.88 | $355.88 | $400.00 | |
Health Alliance Plan
| Professional | $355.88 | $355.88 | $462.64 | |
Molina
| Professional | $30.00 | $30.00 | $100.00 | |
United
| Professional | $480.00 | $480.00 | $517.34 |