| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,170.19 | $3,684.00 | $18,600.00 | |
Medica
| Facility | $1,076.78 | $2,744.00 | $13,541.98 | |
Medica
| Facility | AS | $1,314.53 | $1,314.53 | $1,314.53 |
United
| Facility | $1,570.00 | $6,980.00 | $13,541.98 |