| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,398.00 | $8,578.50 | $19,669.71 | |
Aetna
| Professional | $2,398.00 | $2,398.00 | $4,916.51 | |
Medica
| Facility | $2,398.00 | $2,398.00 | $4,856.00 | |
Medica
| Professional | $2,453.46 | $2,453.46 | $7,342.05 |