| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $204.47 | $204.47 | $204.47 | |
Aetna
| Professional | $204.47 | $204.47 | $204.47 | |
BCBS
| Facility | $452.37 | $452.37 | $452.37 | |
BCBS
| Professional | $315.00 | $408.72 | $613.79 | |
Medcost
| Facility | $198.55 | $198.55 | $204.47 | |
United
| Professional | $232.44 | $379.57 | $495.83 |