| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $85.11 | $85.11 | $85.11 | |
Aetna
| Professional | $85.11 | $85.11 | $85.11 | |
Cigna
| Professional | $42.66 | $42.66 | $42.66 | |
Health Alliance Plan
| Facility | $85.11 | $85.11 | $85.11 | |
Health Alliance Plan
| Professional | $85.11 | $85.11 | $85.11 | |
Priority Health
| Professional | $42.66 | $42.66 | $42.66 |