| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $266.83 | $266.83 | $266.83 | |
BCBS
| Professional | $380.00 | $380.00 | $380.00 | |
Providence
| Facility | $456.67 | $456.67 | $456.67 | |
Providence
| Professional | $267.20 | $400.86 | $578.20 |