| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,221.60 | $3,684.00 | $18,600.00 | |
Medica
| Facility | $1,200.73 | $1,726.20 | $18,992.00 | |
Medica
| Facility | AS | $493.20 | $493.20 | $493.20 |
United
| Facility | $1,960.00 | $9,469.00 | $20,190.00 |