| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $3,768.95 | $3,768.95 | $3,768.95 | |
Aetna
| Professional | $3,768.95 | $3,768.95 | $3,768.95 | |
Medcost
| Facility | $3,768.95 | $3,768.95 | $4,522.74 | |
Wellcare
| Facility | $100.00 | $100.00 | $2,667.60 |