| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $104.40 | $104.40 | $104.40 | |
Aetna
| Professional | $104.40 | $104.40 | $104.40 | |
BCBS
| Facility | $91.99 | $91.99 | $132.38 | |
BCBS
| Professional | $73.59 | $91.99 | $91.99 | |
Medica
| Facility | $104.40 | $104.40 | $104.40 |