| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $37.07 | $37.07 | $37.07 | |
Aetna
| Professional | $37.07 | $41.41 | $69.97 | |
Ambetter
| Professional | $99.22 | $99.22 | $99.22 | |
Qualchoice
| Professional | $123.02 | $123.02 | $123.02 | |
United
| Professional | $61.09 | $75.87 | $115.23 |