| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $68.01 | $68.01 | $118.75 | |
Aetna
| Professional | $68.01 | $101.40 | $118.75 | |
BCBS
| Facility | $866.88 | $866.88 | $866.88 | |
BCBS
| Professional | $190.00 | $190.00 | $190.00 | |
Molina
| Professional | $21.25 | $42.50 | $50.00 |