| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $28.52 | $28.52 | $28.52 | |
Aetna
| Professional | $28.52 | $28.52 | $28.52 | |
BCBS
| Facility | $4.38 | $4.62 | $4.62 | |
BCBS
| Professional | $4.57 | $4.57 | $4.57 | |
Medica
| Facility | $28.52 | $28.52 | $39.07 | |
Medica
| Professional | $1,975.05 | $1,975.05 | $1,975.05 |