| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $0.03 | $0.03 | $0.03 | |
Aetna
| Professional | $0.03 | $0.03 | $0.03 | |
CareSource
| Facility | $15.86 | $25.31 | $33.75 | |
CareSource
| Professional | $37.04 | $37.04 | $37.04 | |
Cigna
| Facility | $7.00 | $7.00 | $7.00 | |
Cigna
| Professional | $0.04 | $20.03 | $20.03 |