| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $206.72 | $206.72 | $206.72 | |
Aetna
| Professional | $206.72 | $206.72 | $206.72 | |
BCBS
| Facility | $0.98 | $38.95 | $137.72 | |
BCBS
| Professional | $31.16 | $38.95 | $38.95 | |
Medica
| Facility | $206.72 | $206.72 | $349.36 |