| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $64.80 | $64.80 | $64.80 | |
Aetna
| Professional | $64.80 | $64.80 | $64.80 | |
BCBS
| Facility | $1.00 | $19.07 | $19.07 | |
BCBS
| Professional | $14.50 | $18.51 | $19.07 | |
Cigna
| Professional | $27.79 | $27.79 | $27.79 | |
Medica
| Facility | $64.80 | $64.80 | $109.51 |