| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $136.15 | $136.15 | $136.15 | |
Aetna
| Professional | $103.93 | $104.46 | $136.15 | |
BCBS
| Professional | $253.31 | $253.31 | $253.31 | |
Medica
| Facility | $89.20 | $104.46 | $139.97 | |
Medica
| Professional | $677.88 | $677.88 | $677.88 |