| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $55.69 | $55.69 | $8,500.00 | |
Aetna
| Professional | $55.69 | $55.69 | $78.45 | |
Medica
| Facility | $55.69 | $94.67 | $3,645.65 | |
Medica
| Professional | $84.81 | $155.63 | $217.37 | |
United
| Professional | $93.50 | $165.76 | $2,955.08 |