| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $10.00 | $10.00 | $10.00 | |
Aetna
| Professional | $12.02 | $15.85 | $19.95 | |
BCBS
| Facility | $194.98 | $194.98 | $194.98 | |
BCBS
| Professional | $36.31 | $36.31 | $36.31 | |
Molina
| Professional | $21.38 | $42.66 | $70.79 |