| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $21.66 | $21.66 | $21.66 | |
Aetna
| Professional | $20.38 | $21.66 | $21.66 | |
CareSource
| Facility | $32,999.67 | $44,999.55 | $44,999.55 | |
Cigna
| Facility | $85.00 | $85.00 | $85.00 | |
Cigna
| Professional | $32.36 | $32.36 | $32.36 |