| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $975.04 | $8,004.08 | $10,499.71 | |
Aetna
| Facility | 50 | $2,618.32 | $6,553.58 | $8,887.32 |
Medica
| Facility | $647.19 | $2,882.74 | $7,049.08 | |
Medica
| Facility | 50 | $243.03 | $4,881.46 | $16,995.00 |