| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Ambetter
| Facility | $18.67 | $18.67 | $18.67 | |
Cigna
| Facility | $42.00 | $42.00 | $42.00 |
Clinic - Pediatric Clinic
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Ambetter
| Facility | $18.67 | $18.67 | $18.67 | |
Cigna
| Facility | $42.00 | $42.00 | $42.00 |