| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $14.88 | $14.88 | $14.88 | |
Aetna
| Professional | $14.88 | $17.48 | $17.48 | |
CareSource
| Facility | $52.34 | $231.74 | $490.73 | |
CareSource
| Professional | $119,998.80 | $119,998.80 | $119,998.80 | |
Cigna
| Facility | $17.53 | $17.53 | $17.53 | |
Cigna
| Professional | $73.26 | $73.26 | $73.26 | |
United
| Professional | $12.25 | $20.32 | $35.79 |