| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,200.00 | $3,779.00 | $12,600.00 | |
Medica
| Facility | $1,515.00 | $2,830.93 | $5,690.67 | |
Medica
| Facility | 62 | $6,409.11 | $6,409.11 | $6,409.11 |
United
| Facility | $880.00 | $2,900.00 | $5,543.93 |