| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $71.54 | $72.81 | $95.39 | |
Aetna
| Professional | $64.98 | $81.08 | $99.02 | |
Aetna
| Professional | 25 | $75.44 | $75.44 | $75.44 |
CareSource
| Facility | $64.27 | $73.03 | $136.33 | |
Cigna
| Facility | $91.25 | $91.25 | $91.25 | |
Cigna
| Professional | $79.51 | $160.00 | $374.18 | |
United
| Professional | $56.78 | $84.44 | $149.72 |