| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,032.28 | $3,684.00 | $18,600.00 | |
Medica
| Facility | $773.00 | $1,314.09 | $5,882.00 | |
Medica
| Facility | AS | $417.36 | $417.36 | $417.36 |
United
| Facility | $350.00 | $1,760.00 | $6,155.68 |