| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,536.50 | $3,073.00 | $4,338.00 | |
Aetna
| Professional | $1,855.80 | $4,152.74 | $4,152.74 | |
Medica
| Facility | $1,643.00 | $1,643.00 | $1,643.00 | |
United
| Facility | $1,643.00 | $1,643.00 | $1,643.00 |