| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $103.17 | $103.17 | $8,500.00 | |
Aetna
| Professional | $103.17 | $103.17 | $157.26 | |
Medica
| Facility | $103.17 | $103.17 | $309.51 | |
Medica
| Professional | $171.15 | $292.16 | $381.18 | |
United
| Professional | $167.44 | $311.18 | $381.18 |