| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $3,801.89 | $3,801.89 | $3,801.89 | |
Aetna
| Professional | $3,801.89 | $3,801.89 | $3,801.89 | |
Medica
| Facility | $3,801.89 | $3,801.89 | $5,248.07 | |
Medica
| Professional | $2,344.23 | $2,344.23 | $3,801.89 |