| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,346.00 | $3,909.00 | $18,600.00 | |
Medica
| Facility | $350.00 | $3,694.87 | $6,272.82 | |
Medica
| Facility | AS | $1,447.81 | $1,447.81 | $1,447.81 |
United
| Facility | $350.00 | $1,760.00 | $6,155.68 |