| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $23.45 | $23.45 | $37.74 | |
BCBS
| Facility | $175.00 | $175.00 | $175.00 | |
BCBS
| Professional | $175.00 | $175.00 | $175.00 | |
Cigna
| Facility | $6.07 | $16.28 | $27.82 | |
Molina
| Professional | $17.00 | $20.00 | $40.00 |