| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $78.12 | $78.12 | $78.12 | |
Aetna
| Professional | $78.12 | $112.32 | $112.32 | |
Ambetter
| Professional | $102.30 | $102.30 | $102.30 | |
Cigna
| Professional | $2.00 | $2.00 | $2.00 | |
Horizon BCBS
| Professional | $74.38 | $74.38 | $87.50 |