| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $64.00 | $64.00 | $64.00 | |
Aetna
| Professional | $64.00 | $64.00 | $64.00 | |
BCBS
| Facility | $5,456.92 | $5,821.21 | $8,577.84 | |
Cigna
| Facility | $64.00 | $64.00 | $64.00 | |
Cigna
| Professional | $106.99 | $106.99 | $106.99 |