| 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 | $508.74 | |
BCBS
| Facility | $84.17 | $103.33 | $550.73 | |
BCBS
| Professional | $82.66 | $103.33 | $103.33 | |
Medica
| Facility | $146.74 | $146.74 | $278.45 | |
Medica
| Professional | $422.40 | $422.40 | $422.40 |