| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $38.02 | $165.96 | $165.96 | |
BCBS
| Facility | $234.42 | $234.42 | $269.15 | |
CareSource
| Facility | $151.36 | $190.55 | $269.15 | |
Health Alliance Plan
| Facility | $123.03 | $165.96 | $446.68 |