| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $77.62 | $77.62 | $77.62 | |
Aetna
| Professional | $91.20 | $107.15 | $125.89 | |
CareSource
| Facility | $125.89 | $162.18 | $208.93 | |
CareSource
| Professional | $117.49 | $234.42 | $275.42 |