| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,398.00 | $26,727.34 | $33,445.51 | |
Aetna
| Professional | $2,398.00 | $2,398.00 | $2,398.00 | |
Medcost
| Facility | $2,398.00 | $2,398.00 | $3,117.40 | |
Wellcare
| Facility | $100.00 | $100.00 | $8,259.79 |