| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $18.41 | $18.41 | $18.41 | |
Aetna
| Professional | $4.05 | $18.41 | $119.00 | |
BCBS
| Facility | $1.00 | $29.54 | $29.54 | |
BCBS
| Professional | $24.31 | $28.65 | $29.54 | |
Medica
| Facility | $18.41 | $18.41 | $31.11 |