| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,285.28 | $1,285.28 | $1,285.28 | |
Aetna
| Professional | $360.00 | $360.00 | $519.54 | |
Cigna
| Facility | $408.33 | $408.33 | $408.33 | |
Cigna
| Professional | $109.45 | $109.45 | $136.81 |