| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $173.00 | $173.00 | $173.00 | |
Aetna
| Professional | $173.00 | $173.00 | $173.00 | |
BCBS
| Facility | $139.69 | $139.69 | $822.33 | |
BCBS
| Professional | $111.76 | $139.69 | $139.69 | |
Cigna
| Facility | $263.02 | $263.02 | $263.02 | |
Cigna
| Professional | $103.50 | $263.02 | $263.02 | |
Medica
| Facility | $161.19 | $173.00 | $178.19 | |
Medica
| Professional | $614.21 | $614.21 | $614.21 | |
United
| Professional | $614.21 | $614.21 | $614.21 |