| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $203.58 | $203.58 | $203.58 | |
Aetna
| Professional | $194.22 | $194.22 | $203.58 | |
CareSource
| Facility | $279.05 | $44,999.55 | $69,999.30 | |
Cigna
| Facility | $85.00 | $206.70 | $206.70 | |
Cigna
| Professional | $206.70 | $206.70 | $206.70 | |
United
| Professional | $226.98 | $234.00 | $234.00 |