| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $112.20 | $112.20 | $112.20 | |
Aetna
| Professional | $89.13 | $107.15 | $141.25 | |
BCBS
| Professional | $208.93 | $208.93 | $208.93 | |
Medica
| Facility | $95.50 | $117.49 | $169.82 | |
Medica
| Professional | $741.31 | $741.31 | $741.31 |