| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $123.25 | $123.25 | $123.25 | |
Aetna
| Professional | $116.00 | $123.25 | $123.25 | |
Anthem BCBS
| Professional | $0.02 | $0.02 | $123.25 | |
Cigna
| Facility | $123.25 | $123.25 | $123.25 | |
Medcost
| Facility | $120.35 | $123.25 | $208.29 |