| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $70.00 | $70.00 | $70.00 | |
Aetna
| Professional | $70.00 | $70.00 | $70.00 | |
BCBS
| Professional | $149.86 | $149.86 | $149.86 | |
Medica
| Facility | $70.00 | $71.40 | $95.90 | |
Medica
| Professional | $259.38 | $259.38 | $259.38 |