| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $4,365.16 | $4,365.16 | $4,365.16 | |
Medica
| Facility | $1,659.59 | $1,659.59 | $1,659.59 | |
Medica
| Professional | $5,754.40 | $5,754.40 | $5,754.40 | |
United
| Facility | $1,659.59 | $1,659.59 | $1,659.59 |