| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $400.00 | $400.00 | $400.00 | |
Aetna
| Professional | $87.57 | $400.00 | $400.00 | |
Cigna
| Professional | $195.75 | $195.75 | $195.75 | |
MVP Health Care
| Professional | $195.75 | $195.75 | $195.75 |