| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $248.71 | $248.71 | $248.71 | |
Aetna
| Professional | $248.71 | $248.71 | $248.71 | |
BCBS
| Facility | $105.00 | $105.00 | $105.00 | |
BCBS
| Professional | $105.00 | $105.00 | $105.00 | |
Molina
| Professional | $17.00 | $21.25 | $50.00 |