| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $31.88 | $31.88 | $56.48 | |
Aetna
| Professional | $31.88 | $31.88 | $56.48 | |
Cigna
| Facility | $350.09 | $350.09 | $416.78 | |
Cigna
| Professional | $3.20 | $3.20 | $3.20 | |
Wellpoint
| Professional | $1.00 | $1.00 | $1.00 |