| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $110.15 | $110.15 | $110.15 | |
Aetna
| Professional | $110.15 | $110.15 | $142.26 | |
Cigna
| Professional | $66.00 | $66.00 | $66.00 | |
MVP Health Care
| Professional | $66.00 | $66.00 | $66.00 |