| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $141.27 | $141.27 | $1,400.00 | |
Aetna
| Professional | $141.27 | $206.43 | $1,121.80 | |
CareSource
| Facility | $208.16 | $281.02 | $343.46 | |
CareSource
| Professional | $312.24 | $482.63 | $482.63 |