| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $40.74 | $40.74 | $40.74 | |
Aetna
| Professional | $37.15 | $42.66 | $60.26 | |
Health Alliance Plan
| Facility | $40.74 | $40.74 | $40.74 | |
Health Alliance Plan
| Professional | $37.15 | $41.69 | $60.26 |