| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $146.74 | $146.74 | $146.74 | |
Aetna
| Professional | $146.74 | $146.74 | $146.74 | |
BCBS
| Professional | $472.80 | $472.80 | $472.80 | |
Medica
| Facility | $146.74 | $152.66 | $214.06 | |
Medica
| Professional | $422.40 | $422.40 | $422.40 |