| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $110.15 | $142.26 | $142.26 | |
Ambetter
| Professional | $62.75 | $62.75 | $62.75 | |
Cigna
| Professional | $66.00 | $66.00 | $66.00 | |
Medcost
| Facility | $110.15 | $142.26 | $177.83 | |
Molina
| Professional | $30.00 | $30.00 | $30.00 |