| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $628.69 | $628.69 | $10,000.00 | |
Aetna
| Professional | $628.69 | $628.69 | $855.64 | |
Medica
| Facility | $628.69 | $1,068.77 | $1,886.07 | |
Medica
| Professional | $946.27 | $1,701.22 | $2,322.48 | |
United
| Professional | $996.59 | $1,770.35 | $2,322.48 |