| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $82.87 | $82.87 | $144.69 | |
Aetna
| Professional | $82.87 | $131.54 | $144.69 | |
BCBS
| Facility | $155.40 | $155.40 | $170.94 | |
BCBS
| Professional | $178.00 | $178.00 | $178.00 | |
Molina
| Professional | $17.00 | $25.00 | $50.00 |