| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $680.30 | $680.30 | $8,500.00 | |
Medica
| Facility | $647.66 | $777.19 | $2,040.90 | |
Medica
| Facility | 50 | $2,769.43 | $2,769.43 | $2,769.43 |
United
| Facility | $2,545.00 | $2,545.00 | $2,545.00 |