| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $77.91 | $77.91 | $77.91 | |
Aetna
| Professional | $77.91 | $77.91 | $150.00 | |
Anthem BCBS
| Facility | $102.48 | $102.48 | $197.79 | |
Anthem BCBS
| Professional | $102.48 | $102.48 | $141.41 | |
Cigna
| Professional | $135.27 | $135.27 | $135.27 |