| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $132.88 | $132.88 | $481.65 | |
Aetna
| Professional | $132.88 | $132.88 | $231.75 | |
BCBS
| Facility | $84.44 | $115.58 | $256.58 | |
BCBS
| Professional | $250.98 | $313.73 | $313.73 | |
Medica
| Facility | $132.88 | $182.98 | $245.00 | |
Medica
| Professional | $465.75 | $465.75 | $465.75 |