| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,398.00 | $2,398.00 | $18,733.05 | |
Aetna
| Professional | $2,398.00 | $2,398.00 | $2,398.00 | |
Medica
| Facility | $2,398.00 | $2,398.00 | $4,987.84 | |
Medica
| Professional | $7,342.05 | $7,342.05 | $7,342.05 |