| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $3,871.86 | $3,871.86 | $3,871.86 | |
Aetna
| Professional | $42.66 | $52.85 | $62.88 | |
CareSource
| Facility | $63.52 | $85.75 | $104.81 | |
CareSource
| Professional | $95.28 | $147.27 | $147.27 |