| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,671.00 | $3,617.00 | $6,329.00 | |
Aetna
| Professional | $153.10 | $169.58 | $350.67 | |
Medica
| Facility | $153.10 | $186.82 | $331.42 | |
Medica
| Professional | $1,116.36 | $1,116.36 | $1,116.36 |