| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $234.48 | $404.13 | $589.29 | |
Cigna
| Professional | $104.51 | $104.51 | $104.51 | |
Health Alliance Plan
| Professional | $404.13 | $404.13 | $439.79 | |
Molina
| Professional | $30.00 | $30.00 | $55.00 |