| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $80.75 | $80.75 | $81.72 | |
Aetna
| Professional | $80.91 | $80.91 | $81.72 | |
CareSource
| Facility | $80.91 | $121.37 | $121.37 | |
Cigna
| Facility | $76.33 | $79.45 | $80.91 | |
Cigna
| Professional | $80.91 | $80.91 | $146.41 | |
United
| Professional | $79.45 | $80.91 | $93.48 |