| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $40.00 | $40.00 | $40.00 | |
Aetna
| Professional | $40.00 | $40.00 | $40.00 | |
Cigna
| Professional | $139.72 | $139.72 | $139.72 | |
Horizon BCBS
| Professional | $116.51 | $137.07 | $137.07 |