| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,009.00 | $1,009.00 | $1,009.00 | |
Aetna
| Professional | $999.03 | $999.03 | $999.03 | |
BCBS
| Facility | $0.95 | $1.00 | $1.00 | |
BCBS
| Professional | $186.01 | $347.56 | $540.20 | |
Medica
| Facility | $100.00 | $100.00 | $999.03 |