| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $124.01 | $124.01 | $216.53 | |
Aetna
| Professional | $124.01 | $196.85 | $216.53 | |
BCBS
| Facility | $207.90 | $207.90 | $228.69 | |
BCBS
| Professional | $171.08 | $171.08 | $171.08 | |
Molina
| Professional | $21.25 | $42.50 | $50.00 |