| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $25.00 | $25.00 | $25.00 | |
Aetna
| Professional | $25.00 | $25.00 | $25.00 | |
CareSource
| Facility | $28.08 | $33.26 | $58.32 | |
CareSource
| Professional | $30.24 | $30.24 | $51.84 | |
Cigna
| Facility | $32.74 | $32.74 | $32.74 | |
Cigna
| Professional | $23.90 | $30.18 | $32.74 |