| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $260.01 | $260.01 | $260.01 | |
Aetna
| Professional | $260.01 | $260.01 | $260.01 | |
BCBS
| Professional | $25,233.00 | $25,233.00 | $25,233.00 | |
Cigna
| Professional | $673.03 | $673.03 | $673.03 | |
Medcost
| Facility | $218.00 | $260.01 | $340.00 |