| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $352.00 | $352.00 | $352.00 | |
Aetna
| Professional | $252.64 | $252.64 | $252.64 | |
BCBS
| Facility | $77.02 | $79.40 | $313.77 | |
BCBS
| Professional | $421.68 | $421.68 | $421.68 | |
Medica
| Facility | $252.64 | $756.54 | $1,038.05 |