| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $102.54 | $102.54 | $102.54 | |
Aetna
| Professional | $99.11 | $102.54 | $122.42 | |
Ambetter
| Professional | $26.78 | $55.34 | $55.34 | |
Cigna
| Professional | $9.85 | $9.85 | $9.85 | |
Qualchoice
| Professional | $30.80 | $63.64 | $63.64 |