| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $264.01 | $264.01 | $264.01 | |
Aetna
| Professional | $264.01 | $264.01 | $264.01 | |
Anthem BCBS
| Professional | $52.50 | $63.00 | $77.00 | |
United
| Professional | $212.45 | $313.95 | $364.07 |