| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,400.00 | $1,400.00 | $1,600.00 | |
Aetna
| Professional | $65.00 | $65.00 | $65.00 | |
CareSource
| Professional | $119,998.80 | $119,998.80 | $119,998.80 | |
United
| Facility | $4,439.00 | $4,439.00 | $4,439.00 |