| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $233.56 | $233.56 | $233.56 | |
Aetna
| Professional | $233.56 | $233.56 | $233.56 | |
Medica
| Facility | $233.56 | $293.64 | $637.62 | |
Medica
| Professional | $2,536.35 | $2,536.35 | $2,536.35 |