| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $30.00 | $32.00 | $33.00 | |
BCBS
| Facility | $4.09 | $4.09 | $4.09 | |
Health Alliance Plan
| Facility | $355.59 | $355.59 | $355.59 | |
Health Alliance Plan
| Professional | $355.59 | $355.59 | $426.70 |