| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $6,932.50 | $6,932.50 | $6,932.50 | |
Medica
| Facility | $6,932.50 | $6,932.50 | $11,785.25 | |
Medica
| Professional | $413.52 | $413.52 | $6,932.50 | |
United
| Professional | $413.52 | $413.52 | $413.52 |