| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 54 | $199.00 | $237.51 | $383.34 |
Cigna
| Facility | 54 | $383.22 | $383.22 | $383.22 |
Lucent Health
| Facility | 54 | $1,051.20 | $1,170.09 | $1,170.09 |
Providence
| Facility | 54 | $383.22 | $383.22 | $654.61 |