| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $906.54 | $906.54 | $906.54 | |
Medica
| Facility | $100.00 | $906.54 | $906.54 | |
Medica
| Professional | $149.68 | $211.42 | $336.05 | |
United
| Professional | $149.68 | $211.42 | $336.05 |