| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $8,511.38 | $8,511.38 | $8,511.38 | |
Aetna
| Professional | $173.78 | $173.78 | $537.03 | |
Medica
| Facility | $446.68 | $446.68 | $1,778.28 | |
United
| Facility | $446.68 | $1,778.28 | $2,570.40 |