| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,300.00 | $3,803.91 | $18,600.00 | |
Medica
| Facility | $1,395.77 | $3,994.11 | $6,272.82 | |
Medica
| Facility | 62 | $9,961.85 | $9,961.85 | $9,961.85 |
Medica
| Facility | AS | $1,593.90 | $1,593.90 | $1,593.90 |
United
| Facility | $350.00 | $1,760.00 | $6,155.68 |