| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $122.70 | $122.70 | $4,599.74 | |
Aetna
| Professional | $6.80 | $137.47 | $650.58 | |
AmeriHealth
| Facility | $149.84 | $444.36 | $42,540.20 | |
Cigna
| Professional | $165.00 | $165.00 | $165.00 |