| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $25.00 | $25.00 | $25.00 | |
Aetna
| Professional | $25.00 | $25.00 | $25.00 | |
CareSource
| Facility | $17.28 | $21.60 | $25.92 | |
CareSource
| Professional | $35,999.64 | $35,999.64 | $41,999.58 | |
Cigna
| Facility | $64.00 | $64.00 | $64.00 | |
Cigna
| Professional | $7.65 | $7.65 | $68.25 |