| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $425.00 | $425.00 | $425.00 | |
Aetna
| Professional | $318.75 | $400.00 | $475.00 | |
Cigna
| Facility | $137.38 | $137.38 | $137.38 | |
Cigna
| Professional | $1,067.00 | $1,067.00 | $1,067.00 |