| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $34.92 | $34.92 | $34.92 | |
Cigna
| Professional | $5.25 | $5.25 | $34.92 | |
MVP Health Care
| Facility | $34.92 | $34.92 | $34.92 | |
MVP Health Care
| Professional | $5.25 | $5.25 | $34.92 |