| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $20.50 | $31.25 | $37.50 | |
Aetna
| Professional | $18.75 | $20.50 | $21.25 | |
CareSource
| Facility | $33.75 | $140.63 | $675.00 | |
CareSource
| Professional | $30.00 | $33.75 | $119,998.80 | |
Cigna
| Facility | $20.30 | $30.00 | $74.98 | |
Cigna
| Professional | $120.50 | $120.50 | $120.50 | |
United
| Professional | $10.50 | $12.50 | $36.25 |