| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $131.83 | $131.83 | $131.83 | |
Aetna
| Professional | $117.49 | $134.90 | $173.78 | |
CareSource
| Facility | $128.82 | $162.18 | $213.80 | |
CareSource
| Professional | $125.89 | $177.83 | $302.00 | |
Cigna
| Facility | $213.80 | $213.80 | $213.80 | |
Cigna
| Professional | $123.03 | $173.78 | $630.96 | |
Highmark BCBS
| Professional | $169.82 | $177.83 | $275.42 | |
United
| Professional | $107.15 | $151.36 | $218.78 |