| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $128.57 | $128.57 | $128.57 | |
Aetna
| Professional | $73.12 | $128.57 | $217.96 | |
CareSource
| Facility | $59,999.40 | $59,999.40 | $59,999.40 | |
CareSource
| Professional | $35,999.64 | $35,999.64 | $41,999.58 |