| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,949.84 | $5,623.41 | $10,471.29 | |
Aetna
| Professional | $288.40 | $288.40 | $288.40 | |
Medica
| Facility | $288.40 | $707.95 | $2,570.40 | |
United
| Facility | $524.81 | $794.33 | $2,570.40 |