| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $5,133.39 | $5,133.39 | $5,133.39 | |
Aetna
| Professional | $5,133.39 | $5,133.39 | $5,133.39 | |
BCBS
| Professional | $561.86 | $657.51 | $668.87 | |
Medica
| Facility | $80.00 | $5,133.39 | $6,850.00 |