| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $58.28 | $58.28 | $58.28 | |
Aetna
| Professional | $58.28 | $58.28 | $99.45 | |
Anthem BCBS
| Professional | $30.00 | $30.00 | $30.00 | |
Medica
| Facility | $58.28 | $67.02 | $136.16 | |
Medica
| Professional | $178.61 | $178.61 | $178.61 |