| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $537.03 | $537.03 | $537.03 | |
Aetna
| Professional | $537.03 | $537.03 | $870.96 | |
Medica
| Facility | $537.03 | $562.34 | $812.83 | |
Medica
| Professional | $1,288.25 | $1,288.25 | $1,288.25 | |
United
| Facility | $389.05 | $389.05 | $416.87 |