| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $350.00 | $350.00 | $350.00 | |
Aetna
| Professional | $350.00 | $350.00 | $350.00 | |
Medica
| Facility | $350.00 | $350.00 | $490.00 | |
Medica
| Professional | $350.00 | $4,790.84 | $4,790.84 | |
United
| Professional | $4,790.84 | $4,790.84 | $4,790.84 |