| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $131.83 | $131.83 | $131.83 | |
Aetna
| Professional | $109.65 | $144.54 | $194.98 | |
Aetna
| Professional | 25 | $30.20 | $30.20 | $30.20 |
BCBS
| Facility | $257.04 | $316.23 | $363.08 | |
BCBS
| Professional | $112.20 | $131.83 | $208.93 | |
Cigna
| Professional | $208.93 | $208.93 | $208.93 | |
United
| Professional | $102.33 | $141.25 | $208.93 |