| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $130.69 | $130.69 | $130.69 | |
Aetna
| Professional | $78.12 | $112.32 | $130.69 | |
Ambetter
| Professional | $33.02 | $33.02 | $33.02 | |
Cigna
| Professional | $2.00 | $2.00 | $2.00 | |
Medica
| Facility | $100.00 | $130.69 | $146.02 |