| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $165.46 | $165.46 | $165.46 | |
Aetna
| Professional | $165.46 | $167.41 | $202.35 | |
Medica
| Facility | $155.58 | $173.73 | $265.97 | |
Medica
| Professional | $136.01 | $219.37 | $1,274.00 |