| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $109.74 | $109.74 | $109.74 | |
Aetna
| Professional | $109.74 | $129.94 | $130.08 | |
Ambetter
| Professional | $76.52 | $90.00 | $90.00 | |
Cigna
| Professional | $13.17 | $13.17 | $13.17 | |
Qualchoice
| Professional | $88.00 | $103.50 | $103.50 |