| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $107.15 | $107.15 | $107.15 | |
Aetna
| Professional | $93.33 | $107.15 | $239.88 | |
BCBS
| Facility | $229.09 | $229.09 | $229.09 | |
BCBS
| Professional | $141.25 | $229.09 | $229.09 | |
Health Alliance Plan
| Facility | $107.15 | $107.15 | $107.15 | |
Health Alliance Plan
| Professional | $93.33 | $107.15 | $239.88 |