| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $640.00 | $640.00 | $640.00 | |
Aetna
| Professional | $640.00 | $640.00 | $987.52 | |
Medica
| Facility | $915.20 | $1,668.91 | $1,975.04 | |
Midlands
| Professional | $1,146.04 | $1,146.04 | $1,146.04 |