| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $20.00 | $20.00 | $20.00 | |
Aetna
| Professional | $20.00 | $20.00 | $20.00 | |
BCBS
| Facility | $6.81 | $7.17 | $7.17 | |
BCBS
| Professional | $7.10 | $7.10 | $7.10 | |
Medica
| Facility | $20.00 | $20.00 | $26.80 | |
Medica
| Professional | $39.22 | $39.22 | $39.22 |