| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,671.00 | $3,617.00 | $6,329.00 | |
Aetna
| Professional | $250.69 | $254.64 | $458.00 | |
Medica
| Facility | $254.64 | $289.36 | $551.35 | |
Medica
| Professional | $1,813.11 | $1,813.11 | $1,813.11 |