| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $106.78 | $106.78 | $106.78 | |
CareSource
| Facility | $2.09 | $9.25 | $19.57 | |
CareSource
| Professional | $119,998.80 | $119,998.80 | $119,998.80 | |
United
| Professional | $1.68 | $70.08 | $125.98 |