| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $68.95 | $68.95 | $120.41 | |
Aetna
| Professional | $68.95 | $107.62 | $120.41 | |
BCBS
| Facility | $593.75 | $593.75 | $593.75 | |
BCBS
| Professional | $185.00 | $185.00 | $185.00 | |
Molina
| Professional | $21.25 | $42.50 | $50.00 |