| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,630.88 | $34,526.25 | $43,316.91 | |
Aetna
| Professional | $1,630.18 | $1,630.18 | $1,630.18 | |
Medcost
| Facility | $1,630.18 | $1,630.18 | $2,119.23 | |
Wellcare
| Facility | $80.00 | $100.00 | $100.00 |