| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $25.19 | $25.19 | $25.19 | |
Aetna
| Professional | $5.00 | $44.80 | $46.40 | |
Cigna
| Professional | $25.05 | $25.05 | $25.05 | |
Wellpoint
| Professional | $2,500.00 | $2,500.00 | $2,500.00 |