| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,000.00 | $3,467.37 | $6,760.83 | |
Medica
| Facility | $575.44 | $1,513.56 | $5,888.44 | |
Medica
| Facility | AS | $144.54 | $269.15 | $269.15 |
United
| Facility | $891.25 | $3,311.31 | $6,165.95 |