| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $172.53 | $172.53 | $172.53 | |
Aetna
| Professional | $172.53 | $172.53 | $174.56 | |
Medica
| Facility | $157.10 | $181.16 | $241.54 | |
Medica
| Professional | $178.90 | $1,328.36 | $1,328.36 |