| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,290.00 | $9,645.99 | $9,645.99 | |
Aetna
| Professional | $249.30 | $449.10 | $1,246.50 | |
Medica
| Facility | $821.00 | $821.00 | $821.00 | |
United
| Facility | $821.00 | $821.00 | $821.00 |