| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,048.00 | $3,803.00 | $12,600.00 | |
Medica
| Facility | $715.02 | $1,044.16 | $5,882.00 | |
Medica
| Facility | AS | $174.87 | $324.41 | $324.41 |
United
| Facility | $942.00 | $3,888.00 | $6,167.00 |