| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $127.50 | $127.50 | $150.00 | |
Aetna
| Professional | $124.50 | $127.50 | $127.50 | |
CareSource
| Facility | $69,999.30 | $69,999.30 | $69,999.30 | |
Cigna
| Facility | $127.50 | $127.50 | $127.50 | |
Cigna
| Professional | $127.50 | $127.50 | $190.50 | |
United
| Professional | $125.00 | $125.00 | $200.00 |