| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $426.58 | $426.58 | $426.58 | |
Aetna
| Professional | $426.58 | $426.58 | $602.56 | |
Medica
| Facility | $426.58 | $549.54 | $1,288.25 | |
Medica
| Professional | $190.55 | $190.55 | $190.55 |