| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $117.18 | $117.18 | $117.18 | |
Aetna
| Professional | $117.18 | $117.18 | $118.56 | |
BCBS
| Professional | $104.00 | $104.00 | $104.00 | |
Medica
| Facility | $101.03 | $123.04 | $164.05 | |
Medica
| Professional | $117.41 | $902.23 | $902.23 |