| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $7,874.59 | $7,874.59 | $7,874.59 | |
Aetna
| Professional | $7,874.59 | $7,874.59 | $7,874.59 | |
BCBS
| Professional | $1,291.07 | $1,510.84 | $1,536.96 | |
Medica
| Facility | $80.00 | $7,874.59 | $10,569.00 |