| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $69.13 | $69.13 | $69.13 | |
Aetna
| Professional | $69.13 | $77.00 | $178.42 | |
Ambetter
| Professional | $62.90 | $106.00 | $106.00 | |
Cigna
| Professional | $20.93 | $20.93 | $20.93 | |
Horizon BCBS
| Professional | $19.13 | $22.50 | $22.50 |