| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $69.18 | $69.18 | $69.18 | |
Aetna
| Professional | $69.18 | $69.18 | $69.18 | |
Anthem BCBS
| Facility | $0.02 | $0.02 | $0.02 | |
Anthem BCBS
| Professional | $0.02 | $0.02 | $1.00 | |
CareSource
| Facility | $63,095.73 | $63,095.73 | $70,794.58 |