| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $4,365.16 | $4,365.16 | $4,897.79 | |
Aetna
| Professional | $977.24 | $977.24 | $977.24 | |
Medica
| Facility | $812.83 | $812.83 | $812.83 | |
United
| Facility | $812.83 | $812.83 | $812.83 |