| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $239.88 | $239.88 | $239.88 | |
Aetna
| Professional | $239.88 | $239.88 | $316.23 | |
Medica
| Facility | $239.88 | $251.19 | $676.08 | |
Medica
| Professional | $2,691.53 | $2,691.53 | $2,691.53 |