| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $1,177.48 | $1,244.51 | $1,491.06 | |
Cigna
| Professional | 26 | $201.47 | $212.93 | $255.12 |
Cigna
| Professional | TC | $976.02 | $1,031.58 | $1,235.94 |
Health New England
| Professional | $142.32 | $142.32 | $142.32 |