| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $10.28 | $56.82 | $188.56 | |
Aetna
| Facility | 25 | $53.90 | $166.80 | $412.24 |
Anthem BCBS
| Facility | $90.00 | $553.00 | $691.00 | |
CareSource
| Facility | $10.67 | $13.15 | $17.07 | |
Cigna
| Facility | $13.19 | $13.19 | $13.19 |