| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,671.00 | $3,617.00 | $6,329.00 | |
Aetna
| Professional | $183.61 | $199.40 | $220.36 | |
Medica
| Facility | $183.61 | $218.67 | $397.43 | |
Medica
| Professional | $1,334.79 | $1,334.79 | $1,334.79 |