| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $64.57 | $67.61 | $3,630.78 | |
Aetna
| Professional | $64.57 | $67.61 | $70.79 | |
Cigna
| Facility | $69.18 | $69.18 | $69.18 | |
Cigna
| Professional | $69.18 | $69.18 | $69.18 | |
Wellpoint
| Professional | $13.49 | $13.49 | $13.49 |