| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $99.45 | $99.45 | $99.45 | |
Aetna
| Professional | $58.28 | $58.28 | $106.19 | |
Horizon BCBS
| Facility | $229.78 | $573.34 | $613.45 | |
Horizon BCBS
| Professional | $240.13 | $282.50 | $282.50 |