| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $77.62 | $77.62 | $77.62 | |
Aetna
| Professional | $77.62 | $77.62 | $120.23 | |
Anthem BCBS
| Facility | $102.33 | $102.33 | $199.53 | |
Anthem BCBS
| Professional | $102.33 | $102.33 | $158.49 | |
Cigna
| Professional | $134.90 | $134.90 | $134.90 |