| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $111.04 | $111.04 | $111.04 | |
Aetna
| Professional | $106.65 | $111.04 | $127.14 | |
CareSource
| Facility | $59,999.40 | $59,999.40 | $59,999.40 | |
Cigna
| Facility | $64.00 | $64.00 | $64.00 |