| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,200.00 | $1,200.00 | $1,400.00 | |
Aetna
| Professional | $36.00 | $36.00 | $36.00 | |
CareSource
| Facility | $592.30 | $592.30 | $592.30 | |
CareSource
| Professional | $405.00 | $405.00 | $405.00 |