| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $8.00 | $8.00 | $8.00 | |
BCBS
| Facility | $140.00 | $238.00 | $238.00 | |
BCBS
| Professional | $122.50 | $140.00 | $162.75 | |
Medica
| Facility | $8.00 | $8.00 | $12.88 | |
Medica
| Professional | $334.05 | $334.05 | $334.05 |