| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $132.60 | $132.60 | $132.60 | |
CareSource
| Facility | $154.15 | $682.45 | $1,445.18 | |
CareSource
| Professional | $119,998.80 | $119,998.80 | $119,998.80 | |
United
| Professional | $59.87 | $89.49 | $157.26 |