| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,596.29 | $1,596.29 | $4,338.00 | |
Aetna
| Professional | $138.15 | $138.15 | $138.15 | |
Medica
| Facility | $821.00 | $821.00 | $821.00 | |
United
| Facility | $821.00 | $821.00 | $821.00 |