| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $912.27 | $912.27 | $4,338.00 | |
Aetna
| Professional | $912.27 | $912.27 | $16,537.27 | |
Medica
| Facility | $1,541.74 | $1,929.73 | $27,947.99 | |
United
| Facility | $6,571.00 | $6,571.00 | $6,571.00 |