| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $19.95 | $19.95 | $19.95 | |
Aetna
| Professional | $15.85 | $19.95 | $26.92 | |
Health Alliance Plan
| Facility | $19.95 | $19.95 | $19.95 | |
Health Alliance Plan
| Professional | $16.98 | $19.95 | $26.92 |