| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $826.50 | $826.50 | $826.50 | |
Anthem BCBS
| Professional | $25.00 | $25.00 | $29.18 | |
Medica
| Facility | $826.50 | $876.09 | $1,722.84 | |
Medica
| Professional | $75.16 | $75.16 | $75.16 |