| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,288.25 | $3,890.45 | $6,606.93 | |
Medica
| Facility | $346.74 | $2,951.21 | $7,244.36 | |
Medica
| Facility | AS | $1,445.44 | $1,445.44 | $1,445.44 |
United
| Facility | $346.74 | $1,949.84 | $6,165.95 |