| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $912.01 | $2,454.71 | $6,606.93 | |
Aetna
| Professional | $2,570.40 | $4,168.69 | $6,606.93 | |
Medica
| Facility | $138.04 | $630.96 | $1,862.09 | |
United
| Facility | $138.04 | $707.95 | $1,659.59 |