| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $967.75 | $1,004.10 | $1,004.10 | |
Aetna
| Facility | 80 | $288.00 | $288.00 | $288.00 |
Medica
| Facility | $55.00 | $1,173.00 | $4,478.00 | |
United
| Facility | $783.00 | $1,743.00 | $8,198.00 |