| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $140.75 | $140.75 | $140.75 | |
Aetna
| Professional | $140.75 | $140.75 | $154.82 | |
CareSource
| Facility | $140.75 | $211.13 | $211.13 | |
Cigna
| Facility | $147.12 | $161.82 | $161.82 | |
Cigna
| Professional | $161.82 | $161.82 | $320.06 | |
United
| Professional | $144.47 | $173.08 | $231.17 |