| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $30.50 | $34.86 | $38.11 | |
CareSource
| Facility | $3.95 | $29.59 | $46.36 | |
CareSource
| Professional | $4.05 | $31.87 | $48.03 | |
Cigna
| Facility | $37.90 | $37.90 | $67.52 | |
Cigna
| Professional | $37.90 | $37.90 | $280.14 | |
United
| Professional | $24.73 | $33.70 | $50.39 |