| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $104.22 | $104.22 | $104.22 | |
Aetna
| Professional | $104.22 | $104.22 | $212.83 | |
BCBS
| Facility | $394.07 | $394.07 | $394.07 | |
BCBS
| Professional | $0.02 | $0.02 | $0.02 | |
Cigna
| Facility | $126.18 | $166.91 | $179.12 |