| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,300.00 | $3,683.00 | $18,600.00 | |
Medica
| Facility | $773.00 | $3,629.04 | $6,396.48 | |
Medica
| Facility | 62 | $10,707.40 | $10,707.40 | $10,707.40 |
United
| Facility | $350.00 | $1,760.00 | $6,155.68 |