| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $308.72 | $308.72 | $308.72 | |
Aetna
| Professional | $308.72 | $308.72 | $463.69 | |
Anthem BCBS
| Professional | $30.00 | $30.00 | $30.00 | |
Medica
| Facility | $455.42 | $523.73 | $1,064.00 | |
Medica
| Professional | $837.48 | $837.48 | $837.48 |