| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,432.06 | $17,700.00 | $47,385.00 | |
Aetna
| Professional | $1,630.18 | $1,630.18 | $12,109.76 | |
Medica
| Facility | $1,630.18 | $1,630.18 | $4,580.81 | |
Medica
| Professional | $15,997.62 | $15,997.62 | $15,997.62 |