| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $17.10 | $17.10 | $17.10 | |
Aetna
| Professional | $17.10 | $17.10 | $17.10 | |
Anthem BCBS
| Professional | $30.00 | $30.00 | $30.00 | |
Medica
| Facility | $17.10 | $19.67 | $45.83 | |
Medica
| Professional | $282.45 | $282.45 | $282.45 |