| 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 | $58.28 | |
BCBS
| Professional | $133.19 | $156.93 | $171.77 | |
Medica
| Facility | $58.28 | $58.28 | $109.40 | |
United
| Professional | $17.98 | $17.98 | $21.26 |