| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $64.57 | $64.57 | $64.57 | |
Aetna
| Professional | $33.11 | $64.57 | $64.57 | |
Anthem BCBS
| Professional | $3.80 | $3.80 | $3.80 | |
SummaCare
| Facility | $42.66 | $42.66 | $42.66 | |
United
| Facility | $29.51 | $29.51 | $83.18 |