| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $64.00 | $64.00 | $64.00 | |
CareSource
| Facility | $53,899.46 | $53,899.46 | $53,899.46 | |
Cigna
| Facility | $64.00 | $64.00 | $64.00 | |
Cigna
| Professional | $106.99 | $106.99 | $106.99 | |
Molina
| Professional | $45.00 | $45.00 | $45.00 |