| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $87.10 | $87.10 | $87.10 | |
Aetna
| Professional | $69.18 | $87.10 | $112.20 | |
Ambetter
| Professional | $57.54 | $57.54 | $57.54 | |
Anthem BCBS
| Professional | $79.43 | $79.43 | $87.10 | |
Cigna
| Professional | $79.43 | $79.43 | $100.00 | |
Select Health
| Professional | $63.10 | $63.10 | $63.10 |