| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $15.05 | $15.05 | $15.05 | |
Aetna
| Professional | $15.05 | $15.23 | $26.80 | |
BCBS
| Professional | $26.00 | $26.00 | $26.00 | |
Medica
| Facility | $15.05 | $15.99 | $29.15 | |
Medica
| Professional | $17.22 | $119.84 | $119.84 |