| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $87.57 | $87.57 | $87.57 | |
Aetna
| Professional | $87.57 | $87.57 | $755.47 | |
CareSource
| Facility | $35,999.64 | $44,999.55 | $69,999.30 | |
Cigna
| Professional | $512.00 | $512.00 | $512.00 | |
United
| Professional | $367.00 | $367.00 | $367.00 |