| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $870.96 | $2,290.87 | $4,365.16 | |
Aetna
| Professional | $125.89 | $269.15 | $1,380.38 | |
Medica
| Facility | $812.83 | $812.83 | $812.83 | |
United
| Facility | $812.83 | $812.83 | $812.83 |