| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,290.87 | $4,365.16 | $6,165.95 | |
Aetna
| Professional | $1,023.29 | $2,570.40 | $2,570.40 | |
Medica
| Facility | $154.88 | $154.88 | $812.83 | |
United
| Facility | $812.83 | $812.83 | $812.83 |