| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $12.02 | $12.02 | $12.02 | |
Aetna
| Professional | $15.85 | $19.05 | $25.12 | |
BCBS
| Facility | $194.98 | $194.98 | $194.98 | |
BCBS
| Professional | $75.86 | $75.86 | $75.86 | |
Molina
| Professional | $19.95 | $25.12 | $58.88 |