| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $222.75 | $222.75 | $294.31 | |
Aetna
| Facility | 25 | $212.63 | $212.63 | $212.63 |
BCBS
| Facility | $81,499.99 | $81,499.99 | $81,499.99 | |
Providence
| Facility | $9.52 | $16.77 | $59.02 |