| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $36.34 | $36.34 | $36.34 | |
Aetna
| Professional | $27.48 | $29.67 | $36.34 | |
CareSource
| Facility | $52.34 | $231.74 | $458.02 | |
CareSource
| Professional | $119,998.80 | $119,998.80 | $119,998.80 | |
Cigna
| Facility | $39.14 | $39.14 | $39.14 | |
Cigna
| Professional | $162.13 | $162.13 | $162.13 | |
United
| Professional | $52.88 | $69.73 | $136.30 |