| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,000.00 | $2,630.27 | $6,606.93 | |
Medica
| Facility | $660.69 | $5,623.41 | $19,054.61 | |
Medica
| Facility | AS | $302.00 | $302.00 | $302.00 |
United
| Facility | $3,467.37 | $10,715.19 | $20,417.38 |