| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,504.62 | $10,738.39 | $10,738.39 | |
Aetna
| Facility | 50 | $975.04 | $975.04 | $1,512.04 |
Medica
| Facility | $1,504.62 | $1,646.36 | $10,482.00 | |
Medica
| Facility | 50 | $14,558.75 | $14,558.75 | $21,801.00 |