| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $29.39 | $29.39 | $29.39 | |
Aetna
| Professional | $15.60 | $31.41 | $37.13 | |
CareSource
| Facility | $30.94 | $464.06 | $1,039.50 | |
CareSource
| Professional | $119,998.80 | $119,998.80 | $119,998.80 | |
Cigna
| Facility | $39.43 | $39.43 | $39.43 | |
Cigna
| Professional | $155.93 | $155.93 | $155.93 | |
United
| Professional | $21.48 | $31.96 | $52.50 |