| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $77.62 | $194.98 | $194.98 | |
Aetna
| Professional | $77.62 | $77.62 | $144.54 | |
BCBS
| Facility | $407.38 | $630.96 | $1,096.48 | |
BCBS
| Professional | $389.05 | $407.38 | $407.38 | |
Health Alliance Plan
| Facility | $77.62 | $77.62 | $144.54 | |
Health Alliance Plan
| Professional | $77.62 | $77.62 | $151.36 |