| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $688.00 | $688.00 | $688.00 | |
Aetna
| Professional | $688.00 | $688.00 | $23,933.33 | |
Medica
| Facility | $1,162.72 | $2,000.00 | $40,447.33 | |
United
| Facility | $2,000.00 | $2,000.00 | $2,000.00 |