| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,346.00 | $3,684.00 | $18,600.00 | |
Medica
| Facility | $498.00 | $2,050.77 | $6,155.68 | |
Medica
| Facility | 62 | $4,249.09 | $4,249.09 | $4,249.09 |
Medica
| Facility | AS | $679.85 | $679.85 | $679.85 |
United
| Facility | $350.00 | $1,760.00 | $6,155.68 |