| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $94.22 | $94.22 | $164.52 | |
Aetna
| Professional | $94.22 | $149.56 | $164.52 | |
BCBS
| Facility | $109.20 | $109.20 | $120.12 | |
BCBS
| Professional | $104.00 | $104.00 | $104.00 | |
Molina
| Professional | $17.00 | $25.00 | $50.00 |