| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $261.80 | $261.80 | $261.80 | |
Aetna
| Professional | $261.80 | $261.80 | $261.80 | |
BCBS
| Professional | $1,387.95 | $1,387.95 | $1,387.95 | |
Medica
| Facility | $261.80 | $261.80 | $390.58 |