| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $398.11 | $398.11 | $398.11 | |
Aetna
| Professional | $87.10 | $87.10 | $398.11 | |
Cigna
| Professional | $194.98 | $194.98 | $194.98 | |
MVP Health Care
| Professional | $194.98 | $194.98 | $194.98 |