| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $63.12 | $84.16 | $249.18 | |
CareSource
| Facility | $91.85 | $113.28 | $138.35 | |
Cigna
| Facility | $252.31 | $294.85 | $452.31 | |
DeanCare
| Facility | $83.56 | $131.30 | $195.18 | |
Medica
| Facility | $84.16 | $132.57 | $195.18 | |
Prevea360
| Facility | $76.12 | $131.30 | $208.38 | |
Quartz
| Professional | $180.99 | $276.08 | $348.54 | |
Quartz
| Facility | $523.65 | $523.65 | $523.65 |