| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $25.12 | $25.12 | $25.12 | |
Aetna
| Professional | $25.12 | $25.12 | $25.12 | |
BCBS
| Professional | $64.57 | $69.18 | $69.18 | |
Health Alliance Plan
| Professional | $25.12 | $25.12 | $69.18 |