| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $65.91 | $65.91 | $65.91 | |
Aetna
| Professional | $65.91 | $65.91 | $376.39 | |
Anthem BCBS
| Professional | $0.75 | $50.55 | $77.19 | |
CareSource
| Facility | $16,499.62 | $16,499.62 | $23,299.55 |