| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $7,943.28 | $7,943.28 | $7,943.28 | |
Aetna
| Professional | $3,801.89 | $7,943.28 | $7,943.28 | |
Medica
| Facility | $6,760.83 | $7,943.28 | $16,595.87 | |
Medica
| Professional | $5,248.07 | $5,248.07 | $5,248.07 |