| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $127.42 | $1,867.51 | $4,687.85 | |
Cigna
| Facility | $120.00 | $120.00 | $611.00 | |
Cigna
| Facility | 52 | $94.25 | $94.25 | $94.25 |
Martin's Point
| Facility | $125.78 | $127.42 | $5,878.78 |