| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $74.56 | $74.56 | $74.56 | |
Aetna
| Professional | $74.56 | $74.56 | $119.54 | |
BCBS
| Professional | $40.15 | $40.15 | $40.15 | |
Cigna
| Professional | $46.50 | $46.50 | $58.13 | |
Medcost
| Facility | $74.56 | $78.29 | $119.54 |