| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $95.47 | $95.47 | $95.47 | |
Aetna
| Professional | $86.96 | $95.47 | $105.90 | |
CareSource
| Facility | $174.11 | $174.11 | $174.11 | |
CareSource
| Professional | $139.79 | $145.38 | $269.11 |