| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $228.00 | $228.00 | $228.00 | |
Aetna
| Professional | $134.90 | $171.96 | $332.76 | |
BCBS
| Facility | $96.00 | $376.92 | $628.08 | |
BCBS
| Professional | $80.40 | $96.00 | $111.60 | |
Medica
| Facility | $171.96 | $332.76 | $475.85 | |
Medica
| Professional | $491.40 | $491.40 | $491.40 |