| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $35.00 | $35.00 | $35.00 | |
Aetna
| Professional | $35.00 | $35.00 | $35.00 | |
BCBS
| Facility | $23.96 | $25.22 | $25.22 | |
BCBS
| Professional | $24.97 | $24.97 | $24.97 | |
Medica
| Facility | $35.00 | $35.00 | $46.90 | |
Medica
| Professional | $82.24 | $82.24 | $82.24 |