| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $118.18 | $118.18 | $1,400.00 | |
Aetna
| Professional | $118.18 | $169.58 | $261.99 | |
CareSource
| Facility | $173.59 | $234.35 | $286.42 | |
CareSource
| Professional | $260.39 | $402.48 | $402.48 |