| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $175.24 | $175.24 | $8,500.00 | |
Aetna
| Professional | $175.24 | $175.24 | $241.87 | |
Medica
| Facility | $175.24 | $175.24 | $525.72 | |
Medica
| Professional | $286.58 | $489.21 | $673.62 | |
United
| Professional | $245.19 | $472.46 | $673.62 |