| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $117.49 | $117.49 | $117.49 | |
Aetna
| Professional | $114.82 | $120.23 | $123.03 | |
BCBS
| Facility | $724.44 | $724.44 | $724.44 | |
BCBS
| Professional | $83.18 | $87.10 | $107.15 | |
Cigna
| Facility | $123.03 | $123.03 | $123.03 | |
Medcost
| Facility | $120.23 | $131.83 | $204.17 | |
Molina
| Professional | $30.20 | $30.20 | $30.20 |