| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $190.83 | $190.83 | $190.83 | |
Aetna
| Professional | $190.83 | $190.83 | $190.83 | |
BCBS
| Facility | $18.10 | $24.91 | $36.44 | |
BCBS
| Professional | $0.02 | $0.02 | $0.03 | |
United
| Professional | $105.09 | $105.09 | $105.09 |