| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $163.13 | $163.13 | $163.13 | |
Aetna
| Professional | $124.54 | $125.23 | $163.13 | |
BCBS
| Professional | $260.39 | $260.39 | $260.39 | |
Medica
| Facility | $125.23 | $152.56 | $237.99 | |
Medica
| Professional | $887.69 | $887.69 | $887.69 |