| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $77.04 | $77.04 | $78.16 | |
Aetna
| Professional | $77.39 | $77.39 | $78.16 | |
CareSource
| Facility | $77.39 | $116.09 | $116.09 | |
Cigna
| Facility | $73.01 | $77.39 | $85.00 | |
Cigna
| Professional | $77.39 | $77.39 | $141.84 | |
United
| Professional | $77.39 | $77.39 | $112.08 |