| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $173.00 | $173.00 | $173.00 | |
Cigna
| Facility | $263.02 | $263.02 | $263.02 | |
Cigna
| Professional | $192.01 | $192.01 | $270.92 | |
MVP Health Care
| Facility | $263.02 | $263.02 | $263.02 | |
MVP Health Care
| Professional | $192.01 | $263.02 | $270.92 |