| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $5,011.87 | $5,011.87 | $5,011.87 | |
Medica
| Facility | $100.00 | $7,413.10 | $10,000.00 | |
Medica
| Professional | $891.25 | $891.25 | $891.25 | |
United
| Professional | $891.25 | $891.25 | $1,023.29 |