| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $23.15 | $23.15 | $23.15 | |
BCBS
| Facility | $134.00 | $134.00 | $134.00 | |
BCBS
| Professional | $134.00 | $134.00 | $134.00 | |
Cigna
| Facility | $93.00 | $93.00 | $93.00 | |
Cigna
| Professional | $50.59 | $50.59 | $93.00 |