| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,398.83 | $16,595.87 | $19,498.45 | |
Aetna
| Professional | $2,398.83 | $2,398.83 | $4,897.79 | |
Medica
| Facility | $2,398.83 | $2,398.83 | $4,897.79 | |
Medica
| Professional | $2,454.71 | $2,454.71 | $7,413.10 |