| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $368.46 | $368.46 | $683.26 | |
Aetna
| Professional | $368.46 | $368.46 | $368.46 | |
Medica
| Facility | $368.46 | $368.46 | $626.38 | |
United
| Facility | $14,831.36 | $14,831.36 | $14,831.36 |