| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $130.12 | $130.12 | $130.12 | |
Aetna
| Professional | $130.12 | $130.12 | $131.65 | |
Medica
| Facility | $130.12 | $138.22 | $321.42 | |
Medica
| Professional | $144.72 | $330.07 | $1,307.34 |