| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $91.66 | $91.66 | $91.66 | |
Aetna
| Professional | $91.66 | $91.66 | $120.06 | |
BCBS
| Facility | $132.66 | $246.25 | $648.22 | |
BCBS
| Professional | $111.41 | $135.37 | $135.37 | |
Medica
| Facility | $91.66 | $93.33 | $154.91 | |
Medica
| Professional | $560.70 | $560.70 | $560.70 |