| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $21.24 | $21.24 | $21.24 | |
Aetna
| Professional | $21.24 | $21.24 | $21.24 | |
BCBS
| Facility | $157.00 | $157.00 | $157.00 | |
BCBS
| Professional | $18.70 | $22.00 | $22.00 | |
Cigna
| Facility | $64.00 | $64.00 | $64.00 | |
Cigna
| Professional | $228.00 | $228.00 | $228.00 |