| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $15.83 | $18.62 | $18.62 | |
Aetna
| Professional | $15.83 | $15.83 | $15.83 | |
CareSource
| Facility | $69,999.30 | $69,999.30 | $69,999.30 | |
Cigna
| Facility | $85.00 | $85.00 | $85.00 | |
United
| Professional | $6.92 | $17.30 | $17.30 |