| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $171.06 | $171.06 | $171.06 | |
Aetna
| Professional | $171.06 | $171.06 | $207.50 | |
BCBS
| Facility | $212.24 | $212.24 | $212.24 | |
BCBS
| Professional | $175.00 | $225.00 | $369.00 | |
Medcost
| Facility | $166.11 | $166.11 | $171.06 | |
United
| Professional | $174.16 | $199.77 | $260.97 |