| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $4,980.00 | $4,980.00 | $4,980.00 | |
Medica
| Facility | $4,000.00 | $4,000.00 | $4,000.00 |
Loa/Reserved
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $4,980.00 | $4,980.00 | $4,980.00 | |
Medica
| Facility | $4,000.00 | $4,000.00 | $4,000.00 |