| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $45.00 | $45.00 | $45.00 | |
Aetna
| Professional | $45.00 | $45.00 | $45.00 | |
Cigna
| Facility | $379.93 | $379.93 | $379.93 | |
Cigna
| Professional | $277.35 | $277.35 | $379.93 | |
Horizon BCBS
| Professional | $125.38 | $147.50 | $147.50 |