| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $66.66 | $66.66 | $66.66 | |
Aetna
| Professional | $56.08 | $66.66 | $135.66 | |
BCBS
| Professional | $56.83 | $75.22 | $83.58 | |
CareSource
| Facility | $115.57 | $115.57 | $115.57 | |
Cigna
| Professional | $39.93 | $73.14 | $73.14 | |
Qualchoice
| Professional | $163.60 | $163.60 | $163.60 | |
United
| Professional | $64.70 | $92.81 | $161.72 |