| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,122.02 | $2,630.27 | $6,606.93 | |
Medica
| Facility | $489.78 | $1,621.81 | $6,165.95 | |
Medica
| Facility | AS | $588.84 | $588.84 | $588.84 |
United
| Facility | $346.74 | $1,949.84 | $6,165.95 |