| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $376.69 | $376.69 | $376.69 | |
Aetna
| Professional | $376.69 | $376.69 | $376.69 | |
BCBS
| Facility | $336.09 | $481.62 | $1,015.37 | |
Health Alliance Plan
| Facility | $376.69 | $376.69 | $376.69 | |
Health Alliance Plan
| Professional | $375.00 | $376.69 | $376.69 |