| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $220.00 | $220.00 | $220.00 | |
Aetna
| Professional | $1.23 | $9.63 | $38.40 | |
Horizon BCBS
| Professional | $201.88 | $201.88 | $237.50 | |
United
| Professional | $10.00 | $10.00 | $10.00 |