| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,038.68 | $3,683.00 | $18,600.00 | |
Medica
| Facility | $690.00 | $1,347.48 | $5,882.00 | |
Medica
| Facility | AS | $420.09 | $420.09 | $420.09 |
United
| Facility | $350.00 | $1,760.00 | $6,155.68 |