| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $5.01 | $5.01 | $5.01 | |
Aetna
| Professional | $5.01 | $5.01 | $100.00 | |
BCBS
| Professional | $117.49 | $125.89 | $151.36 | |
Medcost
| Facility | $5.62 | $7.41 | $141.25 | |
Molina
| Professional | $30.20 | $30.20 | $30.20 | |
United
| Professional | $107.15 | $125.89 | $125.89 |