| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $252.64 | $252.64 | $252.64 | |
Anthem BCBS
| Professional | $31.94 | $31.94 | $31.94 | |
DeanCare
| Facility | $252.64 | $252.64 | $252.64 | |
Medica
| Facility | $252.64 | $252.64 | $802.29 | |
Molina
| Professional | $50.00 | $58.40 | $70.00 | |
Prevea360
| Facility | $252.64 | $252.64 | $252.64 |