| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,000.00 | $3,742.00 | $18,600.00 | |
Medica
| Facility | $215.85 | $690.00 | $5,882.00 | |
Medica
| Facility | AS | $104.62 | $104.62 | $104.62 |
United
| Facility | $488.00 | $2,268.00 | $6,272.82 |