| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $549.54 | $549.54 | $549.54 | |
Medica
| Facility | $100.00 | $100.00 | $549.54 | |
Medica
| Professional | $4,786.30 | $4,786.30 | $4,786.30 | |
United
| Professional | $4,570.88 | $4,786.30 | $5,248.07 |