| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,300.00 | $3,684.00 | $18,600.00 | |
Medica
| Facility | $1,326.48 | $1,913.19 | $5,594.79 | |
Medica
| Facility | AS | $714.67 | $714.67 | $714.67 |
United
| Facility | $350.00 | $1,760.00 | $6,155.68 |