| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,374.87 | $2,374.87 | $2,374.87 | |
Aetna
| Professional | $2,374.87 | $2,374.87 | $2,497.23 | |
Medica
| Facility | $2,374.87 | $2,374.87 | $2,778.60 | |
Medica
| Professional | $2,374.87 | $2,374.87 | $2,374.87 |