| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $21.38 | $60.26 | $83.18 | |
Aetna
| Professional | $30.20 | $30.90 | $70.79 | |
CareSource
| Facility | $43,651.58 | $83,176.38 | $123,026.88 | |
Cigna
| Facility | $33.88 | $33.88 | $85.11 | |
Cigna
| Professional | $33.88 | $162.18 | $162.18 | |
United
| Facility | $30.90 | $30.90 | $30.90 | |
United
| Professional | $33.88 | $36.31 | $43.65 |