| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $102.57 | $102.58 | $102.58 | |
Aetna
| Professional | $102.58 | $102.58 | $102.58 | |
BCBS
| Facility | $136.88 | $136.88 | $136.88 | |
BCBS
| Professional | $136.88 | $136.88 | $136.88 | |
Cigna
| Professional | $58.65 | $58.65 | $58.65 |