| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $112.20 | $112.20 | $112.20 | |
Aetna
| Professional | $104.71 | $109.65 | $112.20 | |
Cigna
| Facility | $112.20 | $112.20 | $144.54 | |
Cigna
| Professional | $112.20 | $112.20 | $112.20 | |
Emblem Health
| Professional | $36.31 | $36.31 | $38.02 |