| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $5,128.61 | $5,128.61 | $5,128.61 | |
Aetna
| Professional | $5,128.61 | $5,128.61 | $5,128.61 | |
Anthem BCBS
| Professional | $489.78 | $489.78 | $489.78 | |
SummaCare
| Professional | $50.12 | $60.26 | $75.86 |