| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $39.81 | $39.81 | $39.81 | |
Aetna
| Professional | $39.81 | $39.81 | $39.81 | |
Cigna
| Professional | $141.25 | $141.25 | $141.25 | |
Emblem Health
| Professional | $234.42 | $234.42 | $234.42 | |
Horizon BCBS
| Professional | $117.49 | $117.49 | $138.04 |