| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $824.00 | $4,846.00 | $5,634.00 | |
Aetna
| Professional | $372.75 | $800.00 | $1,386.00 | |
CareSource
| Facility | $89,999.10 | $89,999.10 | $89,999.10 | |
CareSource
| Professional | $52,499.48 | $89,999.10 | $89,999.10 |