| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $733.04 | $733.04 | $10,500.00 | |
Aetna
| Professional | $733.04 | $733.04 | $1,023.41 | |
Medica
| Facility | $733.04 | $1,246.17 | $2,199.12 | |
Medica
| Professional | $1,157.39 | $2,064.12 | $2,840.36 | |
United
| Professional | $1,276.06 | $2,198.50 | $2,840.36 |