| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $548.86 | $548.86 | $548.86 | |
Medica
| Facility | $548.86 | $927.57 | $1,503.88 | |
Medica
| Professional | $4,800.00 | $4,800.00 | $5,280.00 | |
United
| Professional | $4,800.00 | $4,800.00 | $5,520.00 |