| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $30.00 | $30.00 | $30.00 | |
Aetna
| Professional | $30.00 | $30.00 | $30.00 | |
CareSource
| Facility | $28.08 | $51.98 | $70.88 | |
CareSource
| Professional | $30.24 | $30.24 | $41,999.58 | |
Cigna
| Facility | $64.00 | $64.00 | $64.00 | |
Cigna
| Professional | $19.32 | $19.32 | $38.50 |