| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $369.68 | $369.68 | $369.68 | |
Aetna
| Professional | $369.68 | $369.68 | $369.68 | |
BCBS
| Professional | $6,258.40 | $6,258.40 | $6,258.40 | |
Medica
| Facility | $369.68 | $369.68 | $506.46 |