| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $585.04 | $585.04 | $585.04 | |
Aetna
| Professional | $585.04 | $585.04 | $585.04 | |
Medica
| Facility | $585.04 | $620.14 | $872.82 | |
Medica
| Professional | $1,385.62 | $1,385.62 | $1,385.62 |