| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $53.30 | $64.39 | $99.43 | |
Aetna
| Facility | 25 | $900.00 | $2,251.39 | $2,749.23 |
Anthem BCBS
| Facility | $136.97 | $136.97 | $264.35 | |
CareSource
| Facility | $87.04 | $114.81 | $136.41 | |
Cigna
| Facility | $111.66 | $111.66 | $111.66 |