| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $253.60 | $253.60 | $253.60 | |
Aetna
| Professional | $1.00 | $253.60 | $253.60 | |
Anthem BCBS
| Professional | $29.25 | $36.57 | $50.46 | |
CareSource
| Facility | $8.75 | $8.75 | $13.56 | |
CareSource
| Professional | $9.19 | $10.94 | $13.12 |