| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $410.25 | $632.99 | $632.99 | |
BCBS
| Professional | $813.00 | $813.00 | $813.00 | |
Providence
| Facility | $1,073.99 | $1,073.99 | $1,073.99 | |
Providence
| Professional | $410.85 | $616.33 | $889.00 |