| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,346.00 | $3,909.00 | $18,600.00 | |
Medica
| Facility | $773.00 | $5,021.46 | $7,207.00 | |
Medica
| Facility | 62 | $12,811.62 | $12,811.62 | $12,811.62 |
United
| Facility | $350.00 | $1,760.00 | $6,155.68 |