| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $5,133.39 | $5,133.39 | $5,133.39 | |
Medica
| Facility | $5,133.39 | $5,133.39 | $8,726.78 | |
Medica
| Professional | $306.20 | $306.20 | $5,133.39 | |
United
| Professional | $306.20 | $306.20 | $306.20 |