| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $321.69 | $321.69 | $321.69 | |
Aetna
| Professional | $321.69 | $321.69 | $435.37 | |
BCBS
| Facility | $1,057.16 | $2,216.51 | $3,868.86 | |
Medcost
| Facility | $321.69 | $388.93 | $614.91 | |
Molina
| Professional | $55.00 | $55.00 | $55.00 |