| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $114.82 | $114.82 | $151.36 | |
Aetna
| Professional | $114.82 | $117.49 | $123.03 | |
Anthem BCBS
| Professional | $44.67 | $44.67 | $63.10 | |
Medica
| Facility | $114.82 | $134.90 | $281.84 | |
Medica
| Professional | $316.23 | $316.23 | $316.23 |