| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $104.69 | $104.69 | $3,693.55 | |
Aetna
| Professional | $104.69 | $104.69 | $104.69 | |
Anthem BCBS
| Professional | $50.63 | $50.63 | $60.51 | |
Medica
| Facility | $104.69 | $121.44 | $253.35 | |
Medica
| Professional | $270.97 | $270.97 | $270.97 |