| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $38.54 | $58.75 | $70.50 | |
Aetna
| Professional | $35.25 | $38.54 | $39.95 | |
CareSource
| Facility | $63.45 | $264.38 | $1,269.00 | |
CareSource
| Professional | $56.40 | $63.45 | $119,998.80 | |
Cigna
| Facility | $38.19 | $56.40 | $140.99 | |
Cigna
| Professional | $226.54 | $226.54 | $226.54 | |
United
| Professional | $19.73 | $21.15 | $63.45 |