| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $19.95 | $19.95 | $19.95 | |
Aetna
| Professional | $19.95 | $19.95 | $19.95 | |
CareSource
| Facility | $10.47 | $10.47 | $10.47 | |
CareSource
| Professional | $9.33 | $9.33 | $9.33 | |
Cigna
| Facility | $64.57 | $64.57 | $64.57 | |
Cigna
| Professional | $28.84 | $28.84 | $28.84 | |
Highmark BCBS
| Facility | $123.03 | $123.03 | $138.04 |