| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $104.40 | $104.40 | $104.40 | |
Aetna
| Professional | $104.40 | $104.40 | $104.40 | |
Anthem BCBS
| Professional | $112.22 | $112.22 | $148.13 | |
CareSource
| Facility | $141.75 | $141.75 | $141.75 | |
Cigna
| Professional | $148.13 | $148.13 | $148.13 |