| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $588.84 | $645.65 | $10,964.78 | |
Aetna
| Facility | 50 | $3,019.95 | $3,019.95 | $3,019.95 |
Medica
| Facility | $645.65 | $870.96 | $1,949.84 | |
United
| Facility | $10,715.19 | $12,022.64 | $12,022.64 |