| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,200.00 | $1,200.00 | $1,400.00 | |
Aetna
| Professional | $126.00 | $126.00 | $126.00 | |
CareSource
| Facility | $5,399.95 | $22,499.78 | $53,999.46 | |
CareSource
| Professional | $119,998.80 | $119,998.80 | $119,998.80 |