| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $47.50 | $47.50 | $47.50 | |
Aetna
| Professional | $38.69 | $54.00 | $60.16 | |
CareSource
| Professional | $119,998.80 | $119,998.80 | $119,998.80 | |
Cigna
| Facility | $65.84 | $65.84 | $65.84 | |
Cigna
| Professional | $171.89 | $171.89 | $171.89 | |
United
| Professional | $40.72 | $66.29 | $108.08 |