| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $89.13 | $89.13 | $89.13 | |
Aetna
| Professional | $69.18 | $85.11 | $112.20 | |
Ambetter
| Professional | $63.10 | $69.18 | $69.18 | |
Cigna
| Professional | $79.43 | $79.43 | $100.00 | |
Medica
| Facility | $69.18 | $91.20 | $100.00 |