| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $4,338.00 | $4,698.26 | $4,698.26 | |
Aetna
| Professional | $626.40 | $626.40 | $626.40 | |
Medica
| Facility | $821.00 | $821.00 | $821.00 | |
United
| Facility | $821.00 | $821.00 | $821.00 |