| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,047.13 | $1,047.13 | $1,047.13 | |
Aetna
| Professional | $691.83 | $1,047.13 | $1,047.13 | |
Medica
| Facility | $977.24 | $1,047.13 | $1,584.89 | |
Medica
| Professional | $1,479.11 | $1,479.11 | $1,479.11 | |
United
| Facility | $371.54 | $371.54 | $389.05 |