| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $640.00 | $640.00 | $640.00 | |
Aetna
| Professional | $640.00 | $640.00 | $1,820.00 | |
BCBS
| Facility | $0.95 | $1.00 | $1.00 | |
BCBS
| Professional | $186.01 | $347.56 | $540.20 | |
Medica
| Facility | $640.00 | $640.00 | $1,152.00 |