| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $90.65 | $90.65 | $90.65 | |
Aetna
| Professional | $80.06 | $80.06 | $90.65 | |
Horizon BCBS
| Facility | $139.82 | $279.27 | $319.20 | |
Horizon BCBS
| Professional | $0.28 | $0.28 | $0.28 | |
United
| Professional | $40.28 | $40.28 | $40.28 |