| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $18.20 | $18.20 | $21.88 | |
Aetna
| Professional | $18.20 | $18.20 | $18.20 | |
Well Sense
| Facility | $2,511.89 | $2,511.89 | $2,511.89 | |
Well Sense
| Professional | $2,511.89 | $2,511.89 | $2,511.89 |