| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $123.03 | $123.03 | $1,548.82 | |
Aetna
| Professional | $114.82 | $120.23 | $123.03 | |
Anthem BCBS
| Professional | $0.02 | $0.02 | $125.89 | |
Medcost
| Facility | $117.49 | $128.82 | $208.93 |