| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $166.83 | $173.09 | $173.09 | |
Aetna
| Professional | $166.83 | $173.09 | $177.26 | |
Cigna
| Facility | $177.26 | $177.26 | $177.26 | |
Cigna
| Professional | $177.26 | $177.26 | $177.26 | |
Wellpoint
| Professional | $156.41 | $156.41 | $156.41 |