| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $109.03 | $109.03 | $109.03 | |
Aetna
| Professional | $81.28 | $109.03 | $109.03 | |
BCBS
| Facility | $219,999.78 | $539,999.46 | $949,999.05 | |
BCBS
| Professional | $169.32 | $224.10 | $249.00 | |
CareSource
| Facility | $190.45 | $190.45 | $196.15 | |
CareSource
| Professional | $190.45 | $190.45 | $190.45 | |
Cigna
| Facility | $112.22 | $112.22 | $156.91 | |
Cigna
| Professional | $81.92 | $81.92 | $147.41 | |
United
| Professional | $57.99 | $88.36 | $118.19 |