| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $50.12 | $50.12 | $50.12 | |
Aetna
| Professional | $50.12 | $50.12 | $50.12 | |
BCBS
| Facility | $100.00 | $269.15 | $537.03 | |
BCBS
| Professional | $95.50 | $100.00 | $104.71 | |
Health Alliance Plan
| Facility | $50.12 | $50.12 | $50.12 | |
Health Alliance Plan
| Professional | $50.12 | $50.12 | $50.12 |