| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $75.15 | $75.15 | $75.15 | |
Aetna
| Professional | $75.15 | $75.15 | $82.66 | |
CareSource
| Facility | $75.15 | $112.73 | $112.73 | |
Cigna
| Facility | $80.88 | $80.88 | $85.00 | |
Cigna
| Professional | $80.88 | $80.88 | $290.12 | |
United
| Professional | $72.20 | $86.51 | $92.20 |