| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $17.10 | $17.10 | $77.67 | |
BCBS
| Facility | $96.00 | $376.92 | $628.08 | |
BCBS
| Professional | $80.40 | $96.00 | $111.60 | |
Medica
| Facility | $17.10 | $77.67 | $111.07 | |
Medica
| Professional | $282.45 | $282.45 | $282.45 |