| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,048.00 | $3,779.00 | $12,600.00 | |
Medica
| Facility | $415.15 | $1,239.00 | $9,232.95 | |
Medica
| Facility | AS | $1,279.44 | $1,279.44 | $1,279.44 |
United
| Facility | $1,280.00 | $5,524.00 | $9,232.95 |