| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $104.71 | $104.71 | $104.71 | |
Aetna
| Professional | $104.71 | $104.71 | $104.71 | |
Anthem BCBS
| Professional | $112.20 | $112.20 | $177.83 | |
Cigna
| Professional | $117.49 | $147.91 | $147.91 |