| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $223.17 | $223.17 | $389.66 | |
Aetna
| Professional | $223.17 | $354.23 | $389.66 | |
BCBS
| Facility | $866.88 | $866.88 | $866.88 | |
BCBS
| Professional | $835.00 | $835.00 | $835.00 | |
Molina
| Professional | $17.00 | $25.00 | $50.00 |