| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $496.64 | $496.64 | $8,500.00 | |
Aetna
| Facility | 50 | $28,327.70 | $28,327.70 | $28,327.70 |
Medica
| Facility | $0.65 | $496.64 | $1,489.92 | |
Medica
| Facility | 50 | $0.84 | $0.84 | $8,002.15 |