| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $150.07 | $150.07 | $150.07 | |
Aetna
| Professional | $146.54 | $150.07 | $150.07 | |
CareSource
| Facility | $44,999.55 | $44,999.55 | $69,999.30 | |
Cigna
| Professional | $150.07 | $150.07 | $150.07 | |
United
| Professional | $136.80 | $136.80 | $176.55 |