| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $128.82 | $138.04 | $147.91 | |
Aetna
| Professional | $128.82 | $134.90 | $162.18 | |
Cigna
| Facility | $138.04 | $138.04 | $138.04 | |
Cigna
| Professional | $138.04 | $138.04 | $162.18 | |
Medcost
| Facility | $138.04 | $147.91 | $165.96 | |
United
| Facility | $173.78 | $173.78 | $194.98 | |
United
| Professional | $331.13 | $331.13 | $436.52 | |
Wellcare
| Facility | $707.95 | $707.95 | $707.95 |