| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $45.60 | $45.60 | $45.60 | |
Aetna
| Professional | $45.60 | $45.60 | $45.60 | |
Anthem BCBS
| Professional | $1,142.74 | $1,142.74 | $1,158.58 | |
Medica
| Facility | $45.60 | $45.60 | $100.00 |