| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $760.00 | $3,576.00 | $7,500.00 | |
Medica
| Facility | $136.19 | $544.99 | $4,000.00 | |
Medica
| Facility | 62 | $340.62 | $340.62 | $340.62 |
Medica
| Facility | AS | $54.50 | $54.50 | $54.50 |
United
| Facility | $139.00 | $610.00 | $1,883.00 |