| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $58.28 | $58.28 | $58.28 | |
Aetna
| Professional | $58.28 | $58.28 | $58.28 | |
BCBS
| Facility | $681.00 | $681.00 | $681.00 | |
BCBS
| Professional | $681.00 | $681.00 | $681.00 | |
Molina
| Professional | $17.00 | $21.25 | $50.00 |