| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,346.00 | $4,728.00 | $14,100.00 | |
Medica
| Facility | $1,105.71 | $2,513.00 | $11,495.55 | |
Medica
| Facility | AS | $432.80 | $432.80 | $432.80 |
United
| Facility | $1,851.00 | $6,980.00 | $13,541.98 |