| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $87.10 | $87.10 | $87.10 | |
Aetna
| Professional | $87.10 | $87.10 | $398.11 | |
Ambetter
| Professional | $21.38 | $21.38 | $89.13 | |
Cigna
| Professional | $288.40 | $288.40 | $295.12 | |
United
| Professional | $81.28 | $81.28 | $380.19 |