| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $63.30 | $63.30 | $110.53 | |
Aetna
| Professional | $63.30 | $100.48 | $110.53 | |
BCBS
| Facility | $187.95 | $187.95 | $206.75 | |
BCBS
| Professional | $179.00 | $179.00 | $179.00 | |
Molina
| Professional | $21.25 | $42.50 | $50.00 |