| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $81.00 | $81.00 | $81.00 | |
BCBS
| Facility | $50.00 | $50.00 | $50.00 | |
BCBS
| Professional | $47.50 | $52.00 | $67.50 | |
Health Alliance Plan
| Professional | $51.50 | $51.50 | $81.00 | |
Molina
| Professional | $30.00 | $30.00 | $55.00 |