| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $32.89 | $32.89 | $57.43 | |
Aetna
| Professional | $32.89 | $52.21 | $57.43 | |
BCBS
| Facility | $593.75 | $593.75 | $593.75 | |
BCBS
| Professional | $81.00 | $81.00 | $81.00 | |
Molina
| Professional | $17.00 | $25.00 | $50.00 |