| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $171.96 | $171.96 | $171.96 | |
Aetna
| Professional | $134.90 | $171.96 | $332.76 | |
BCBS
| Facility | $204.67 | $242.44 | $748.04 | |
BCBS
| Professional | $112.28 | $140.35 | $140.35 | |
Medica
| Facility | $171.96 | $171.96 | $548.04 | |
Medica
| Professional | $491.40 | $491.40 | $491.40 |