| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,288.25 | $3,890.45 | $9,772.37 | |
Medica
| Facility | $1,202.26 | $6,165.95 | $15,135.61 | |
Medica
| Facility | AS | $1,621.81 | $1,621.81 | $1,621.81 |
United
| Facility | $1,949.84 | $7,762.47 | $14,125.38 |