| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $91.66 | $91.66 | $91.66 | |
Aetna
| Professional | $91.66 | $91.66 | $93.33 | |
CareSource
| Facility | $82,011.67 | $82,011.67 | $82,011.67 | |
CareSource
| Professional | $72,899.27 | $72,899.27 | $72,899.27 |