| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $404.52 | $404.52 | $404.52 | |
Aetna
| Professional | $404.52 | $404.52 | $409.28 | |
Medica
| Facility | $404.52 | $429.74 | $1,097.07 | |
Medica
| Professional | $421.13 | $1,180.83 | $3,879.51 |