| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,679.00 | $3,116.00 | $11,581.00 | |
Aetna
| Professional | $488.00 | $2,547.00 | $11,581.00 | |
CareSource
| Facility | $65,624.34 | $65,624.34 | $65,624.34 | |
CareSource
| Professional | $104,998.95 | $104,998.95 | $104,998.95 |