| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $183.30 | $274.48 | $403.26 | |
Aetna
| Facility | 25 | $129.72 | $246.28 | $353.44 |
CareSource
| Facility | $11.05 | $12.16 | $17.07 | |
Cigna
| Facility | $13.19 | $13.19 | $13.19 | |
Highmark BCBS
| Facility | $174.47 | $174.47 | $174.47 |