| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $70.79 | $70.79 | $70.79 | |
Aetna
| Professional | $70.79 | $70.79 | $190.55 | |
Florida Blue
| Professional | $52.48 | $107.15 | $109.65 | |
Molina
| Professional | $50.12 | $50.12 | $70.79 | |
Wellpoint
| Professional | $100.00 | $100.00 | $100.00 |