| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $45.00 | $45.00 | $45.00 | |
Cigna
| Facility | $379.93 | $379.93 | $379.93 | |
Cigna
| Professional | $277.35 | $277.35 | $379.93 | |
Wellpoint
| Professional | $1,078.66 | $1,078.66 | $1,078.66 |