| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,288.25 | $3,890.45 | $9,772.37 | |
Medica
| Facility | $234.42 | $575.44 | $6,165.95 | |
Medica
| Facility | AS | $112.20 | $112.20 | $112.20 |
United
| Facility | $138.04 | $707.95 | $1,659.59 |