| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $138.91 | $138.91 | $138.91 | |
Aetna
| Professional | $138.91 | $138.91 | $138.91 | |
BCBS
| Facility | $151.47 | $151.47 | $166.62 | |
BCBS
| Professional | $5.32 | $5.32 | $5.32 | |
Molina
| Professional | $17.00 | $25.00 | $50.00 |