| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,000.00 | $3,467.37 | $6,760.83 | |
Medica
| Facility | $338.84 | $3,981.07 | $10,232.93 | |
Medica
| Facility | AS | $1,288.25 | $1,288.25 | $1,288.25 |
United
| Facility | $1,621.81 | $6,025.60 | $10,715.19 |