| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $660.69 | $660.69 | $4,365.16 | |
Aetna
| Professional | $660.69 | $660.69 | $1,380.38 | |
Medica
| Facility | $933.25 | $1,995.26 | $3,801.89 | |
United
| Facility | $1,995.26 | $1,995.26 | $1,995.26 |