| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $3,135.99 | $3,135.99 | $8,500.00 | |
Aetna
| Professional | $3,135.99 | $3,135.99 | $3,135.99 | |
Medica
| Facility | $3,135.99 | $3,135.99 | $5,801.58 | |
United
| Facility | $681.00 | $681.00 | $681.00 |