| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,609.27 | $3,085.50 | $7,650.00 | |
Aetna
| Professional | $1,609.27 | $1,609.27 | $1,609.27 | |
Medcost
| Facility | $1,609.27 | $1,609.27 | $2,092.05 | |
Wellcare
| Facility | $80.00 | $100.00 | $100.00 |