| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,000.00 | $3,742.00 | $18,600.00 | |
Medica
| Facility | $262.01 | $418.88 | $5,415.32 | |
Medica
| Facility | AS | $69.92 | $133.22 | $133.22 |
United
| Facility | $350.00 | $1,760.00 | $6,155.68 |