| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $239.37 | $1,574.40 | $1,574.40 | |
Aetna
| Professional | $239.37 | $239.37 | $239.37 | |
Medica
| Facility | $239.37 | $246.55 | $357.12 | |
Medica
| Professional | $448.80 | $448.80 | $448.80 |