| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $4,998.68 | $4,998.68 | $4,998.68 | |
Medica
| Facility | $100.00 | $4,998.68 | $8,447.77 | |
Medica
| Professional | $888.93 | $888.93 | $995.60 | |
United
| Professional | $888.93 | $888.93 | $1,173.39 |