| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $245.47 | $245.47 | $245.47 | |
Aetna
| Professional | $245.47 | $245.47 | $288.40 | |
BCBS
| Facility | $104.71 | $104.71 | $104.71 | |
BCBS
| Professional | $104.71 | $104.71 | $104.71 | |
Molina
| Professional | $19.95 | $25.12 | $58.88 | |
United
| Facility | $380.19 | $524.81 | $776.25 |