| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $115.29 | $115.29 | $115.29 | |
Aetna
| Professional | $115.29 | $115.29 | $116.65 | |
BCBS
| Professional | $172.00 | $172.00 | $172.00 | |
Medica
| Facility | $115.29 | $122.48 | $254.56 | |
Medica
| Professional | $131.79 | $887.69 | $887.69 |