| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $19.50 | $19.50 | $1,400.00 | |
Aetna
| Facility | 52 | $9.75 | $9.75 | $14.59 |
CareSource
| Facility | $20.39 | $22.61 | $24.62 | |
Cigna
| Facility | $21.59 | $21.59 | $21.59 | |
Cigna
| Facility | 52 | $16.70 | $16.70 | $16.70 |