| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,557.09 | $1,557.09 | $1,557.09 | |
Aetna
| Professional | $1,557.09 | $1,557.09 | $1,557.09 | |
Medica
| Facility | $80.00 | $1,557.09 | $4,671.27 | |
Medica
| Professional | $18,012.75 | $18,012.75 | $18,012.75 |