| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,052.08 | $1,052.08 | $1,052.08 | |
Aetna
| Professional | $1,052.08 | $1,052.08 | $1,052.08 | |
Medica
| Facility | $1,052.08 | $1,083.64 | $1,534.77 | |
Medica
| Professional | $1,463.01 | $1,463.01 | $1,463.01 |