| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $10.00 | $10.00 | $10.00 | |
Aetna
| Professional | $7.94 | $10.47 | $15.14 | |
Health Alliance Plan
| Facility | $10.00 | $10.00 | $10.00 | |
Health Alliance Plan
| Professional | $8.91 | $10.47 | $19.05 |