| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,346.00 | $3,684.00 | $18,600.00 | |
Medica
| Facility | $1,655.19 | $2,623.43 | $19,664.12 | |
Medica
| Facility | AS | $746.31 | $746.31 | $746.31 |
United
| Facility | $1,960.00 | $9,469.00 | $20,190.00 |