| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,288.25 | $3,019.95 | $6,606.93 | |
Medica
| Facility | $346.74 | $2,818.38 | $6,309.57 | |
Medica
| Facility | AS | $1,096.48 | $1,096.48 | $1,096.48 |
United
| Facility | $346.74 | $1,949.84 | $6,165.95 |