| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $131.09 | $131.09 | $131.09 | |
Aetna
| Professional | $131.09 | $131.09 | $132.63 | |
Medica
| Facility | $117.93 | $139.27 | $196.79 | |
Medica
| Professional | $117.93 | $240.44 | $1,009.33 |