| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,346.00 | $3,684.00 | $18,600.00 | |
Medica
| Facility | $773.00 | $2,379.34 | $5,991.35 | |
Medica
| Facility | AS | $919.95 | $919.95 | $919.95 |
United
| Facility | $350.00 | $1,760.00 | $6,155.68 |