| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $609.51 | $609.51 | $8,500.00 | |
Aetna
| Facility | 50 | $9,031.36 | $9,031.36 | $9,031.36 |
Medica
| Facility | $609.51 | $713.42 | $1,036.17 | |
Medica
| Facility | 50 | $4,957.79 | $4,957.79 | $4,957.79 |