| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $500.00 | $7,961.62 | $7,961.62 | |
Aetna
| Professional | $7,961.62 | $7,961.62 | $7,961.62 | |
Medica
| Facility | $3,775.00 | $7,961.62 | $15,525.16 | |
Medica
| Professional | $5,256.46 | $5,256.46 | $5,256.46 |