| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $109.65 | $109.65 | $109.65 | |
Aetna
| Professional | $109.65 | $141.25 | $141.25 | |
Cigna
| Professional | $66.07 | $66.07 | $66.07 | |
Horizon BCBS
| Professional | $128.82 | $151.36 | $151.36 |