| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $973.77 | $973.77 | $973.77 | |
Aetna
| Professional | $973.77 | $973.77 | $1,194.00 | |
Medica
| Facility | $973.77 | $973.77 | $1,168.52 | |
Medica
| Professional | $1,420.02 | $1,420.02 | $1,420.02 |