| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $173.78 | $173.78 | $173.78 | |
Aetna
| Professional | $158.49 | $186.21 | $223.87 | |
Medica
| Facility | $158.49 | $181.97 | $426.58 | |
Medica
| Professional | $177.83 | $1,318.26 | $1,318.26 |