| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,137.28 | $3,684.00 | $18,600.00 | |
Medica
| Facility | $139.00 | $1,130.00 | $5,882.00 | |
Medica
| Facility | AS | $408.43 | $408.43 | $408.43 |
United
| Facility | $100.00 | $610.00 | $1,883.00 |