| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $130.25 | $130.25 | $8,500.00 | |
Aetna
| Professional | $130.25 | $161.82 | $163.85 | |
Medica
| Facility | $130.25 | $169.33 | $390.75 | |
Medica
| Professional | $203.55 | $335.86 | $455.98 | |
United
| Professional | $203.55 | $262.11 | $417.65 |