| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $310.47 | $310.47 | $310.47 | |
Aetna
| Professional | $310.47 | $310.47 | $314.12 | |
Medica
| Facility | $310.47 | $329.83 | $646.92 | |
Medica
| Professional | $364.01 | $695.33 | $2,390.37 |