| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $3,162.28 | $6,309.57 | $10,471.29 | |
Aetna
| Professional | $3,630.78 | $3,630.78 | $3,630.78 | |
Medica
| Facility | $165.96 | $524.81 | $1,698.24 | |
United
| Facility | $190.55 | $537.03 | $1,905.46 |