| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $77.91 | $77.91 | $77.91 | |
Aetna
| Professional | $77.91 | $77.91 | $77.91 | |
BCBS
| Facility | $0.98 | $121.70 | $716.37 | |
BCBS
| Professional | $97.36 | $121.70 | $121.70 | |
Medica
| Facility | $77.91 | $117.60 | $150.00 |