| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $189.43 | $189.43 | $8,500.00 | |
Aetna
| Professional | $189.43 | $215.20 | $337.08 | |
Medica
| Facility | $189.43 | $373.60 | $512.12 | |
Medica
| Professional | $285.11 | $541.77 | $637.38 | |
United
| Professional | $306.95 | $507.51 | $637.27 |