| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $826.50 | $826.50 | $826.50 | |
Aetna
| Professional | $83.00 | $826.50 | $826.50 | |
BCBS
| Facility | $107.78 | $107.78 | $107.78 | |
BCBS
| Professional | $88.70 | $104.55 | $107.78 | |
Medica
| Facility | $826.50 | $826.50 | $1,396.79 | |
Medica
| Professional | $75.16 | $75.16 | $75.16 |