| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $63.28 | $63.28 | $69.29 | |
Aetna
| Professional | $63.28 | $69.29 | $76.62 | |
CareSource
| Facility | $35,399.65 | $37,499.62 | $69,999.30 | |
Cigna
| Facility | $127.68 | $127.68 | $127.68 | |
Cigna
| Professional | $104.92 | $104.92 | $104.92 |