| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $248.71 | $248.71 | $248.71 | |
Aetna
| Professional | $248.71 | $248.71 | $1,000.00 | |
Medica
| Facility | $248.71 | $248.71 | $305.91 | |
Medica
| Professional | $449.39 | $449.39 | $449.39 |