| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $120.35 | $933.64 | $4,883.64 | |
Aetna
| Professional | $116.00 | $120.35 | $123.25 | |
Cigna
| Professional | $80.54 | $80.54 | $80.54 | |
Wellpoint
| Professional | $45.00 | $45.00 | $45.00 |