| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,174.90 | $2,630.27 | $6,606.93 | |
Medica
| Facility | $1,071.52 | $4,677.35 | $13,489.63 | |
Medica
| Facility | AS | $1,318.26 | $1,318.26 | $1,318.26 |
United
| Facility | $1,949.84 | $7,762.47 | $14,125.38 |