| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $121.97 | $121.97 | $121.97 | |
Aetna
| Professional | $123.40 | $154.34 | $206.97 | |
Medica
| Facility | $121.97 | $128.07 | $1,075.93 | |
Medica
| Professional | $165.95 | $1,066.36 | $1,066.36 |