| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $220.72 | $220.72 | $8,500.00 | |
Aetna
| Professional | $220.72 | $220.72 | $305.19 | |
Medica
| Facility | $220.72 | $220.72 | $662.16 | |
Medica
| Professional | $360.95 | $616.16 | $848.43 | |
United
| Professional | $360.95 | $635.03 | $848.43 |