| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
CareSource
| Facility | $799.95 | $799.95 | $799.95 | |
CareSource
| Professional | $711.07 | $711.07 | $711.07 | |
Cigna
| Professional | $504.27 | $504.27 | $630.34 | |
United
| Professional | $252.88 | $252.88 | $252.88 |