| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $47.89 | $47.89 | $47.89 | |
Aetna
| Professional | $47.89 | $59.53 | $75.00 | |
CareSource
| Facility | $130.93 | $178.55 | $208.30 | |
CareSource
| Professional | $101.05 | $142.84 | $275.98 | |
Cigna
| Facility | $112.59 | $112.59 | $112.59 | |
Cigna
| Professional | $47.79 | $47.79 | $470.87 | |
United
| Professional | $58.14 | $67.09 | $129.55 |