| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $700.00 | $700.00 | $700.00 | |
Aetna
| Professional | $87.65 | $700.00 | $700.00 | |
BCBS
| Facility | $30.33 | $31.27 | $73.01 | |
BCBS
| Professional | $421.68 | $421.68 | $421.68 | |
Medica
| Facility | $185.61 | $700.00 | $1,183.00 |