| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $938.20 | $938.20 | $8,500.00 | |
Aetna
| Facility | 50 | $6,738.26 | $8,798.81 | $21,383.11 |
Medica
| Facility | $938.20 | $1,085.17 | $11,358.63 | |
Medica
| Facility | 50 | $4,197.00 | $4,197.00 | $4,314.75 |