| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,076.51 | $3,684.00 | $18,600.00 | |
Medica
| Facility | $916.74 | $1,329.27 | $4,132.00 | |
Medica
| Facility | AS | $453.09 | $453.09 | $453.09 |
United
| Facility | $350.00 | $1,760.00 | $6,155.68 |