| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $57.54 | $57.54 | $57.54 | |
Aetna
| Professional | $57.54 | $57.54 | $107.15 | |
BCBS
| Facility | $676.08 | $676.08 | $676.08 | |
BCBS
| Professional | $676.08 | $676.08 | $676.08 | |
Molina
| Professional | $19.95 | $25.12 | $58.88 | |
United
| Facility | $109.65 | $630.96 | $977.24 |