| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $254.94 | $254.94 | $254.94 | |
Aetna
| Professional | $17.60 | $254.94 | $622.74 | |
BCBS
| Facility | $1.00 | $1.00 | $1.00 | |
Medica
| Facility | $27.65 | $254.94 | $430.85 | |
Medica
| Professional | $15.64 | $15.64 | $15.64 |