| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $18.20 | $18.20 | $18.20 | |
Aetna
| Professional | $18.20 | $18.20 | $18.20 | |
BCBS
| Professional | $53.70 | $60.26 | $60.26 | |
Medcost
| Facility | $18.20 | $18.20 | $35.48 | |
Wellcare
| Facility | $114.82 | $114.82 | $114.82 |