| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $983.30 | $983.30 | $8,500.00 | |
Aetna
| Facility | 50 | $8,510.40 | $8,967.60 | $8,967.60 |
Medica
| Facility | $701.34 | $983.30 | $2,949.90 | |
Medica
| Facility | 50 | $12,646.50 | $12,646.50 | $12,646.50 |