| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $171.96 | $171.96 | $171.96 | |
Aetna
| Professional | $171.96 | $171.96 | $171.96 | |
Anthem BCBS
| Professional | $281.10 | $650.00 | $650.00 | |
Medica
| Facility | $171.96 | $189.16 | $401.75 | |
Medica
| Professional | $491.40 | $491.40 | $491.40 |