| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $204.17 | $204.17 | $204.17 | |
Aetna
| Professional | $204.17 | $204.17 | $302.00 | |
BCBS
| Facility | $457.09 | $457.09 | $457.09 | |
BCBS
| Professional | $316.23 | $407.38 | $691.83 | |
Medcost
| Facility | $199.53 | $199.53 | $204.17 | |
United
| Facility | $524.81 | $524.81 | $524.81 | |
United
| Professional | $331.13 | $380.19 | $501.19 |