| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $30.00 | $30.00 | $30.00 | |
Aetna
| Professional | $30.00 | $30.00 | $30.00 | |
BCBS
| Facility | $206.90 | $211.12 | $1,390.30 | |
BCBS
| Professional | $168.90 | $211.12 | $211.12 | |
Medica
| Facility | $30.00 | $50.70 | $50.70 |