| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,609.27 | $2,703.57 | $5,740.00 | |
Aetna
| Professional | $1,609.27 | $1,609.27 | $2,114.64 | |
Medica
| Facility | $1,609.27 | $1,609.27 | $2,156.42 | |
Medica
| Professional | $1,609.27 | $1,609.27 | $1,609.27 |