| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $64.00 | $64.00 | $64.00 | |
Aetna
| Professional | $0.02 | $64.00 | $64.00 | |
CareSource
| Facility | $43,749.56 | $59,499.41 | $61,249.39 | |
Molina
| Professional | $40.00 | $50.00 | $60.00 |