| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $173.78 | $173.78 | $173.78 | |
Aetna
| Professional | $162.18 | $173.78 | $173.78 | |
Anthem BCBS
| Professional | $30.20 | $30.20 | $30.20 | |
United
| Facility | $107.15 | $107.15 | $107.15 | |
United
| Professional | $125.89 | $125.89 | $125.89 |