| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $56.99 | $70.17 | $123.10 |
Cigna
| Facility | 26 | $99.24 | $99.24 | $99.24 |
Lucent Health
| Facility | 26 | $203.34 | $422.89 | $422.89 |
Providence
| Facility | 26 | $99.24 | $99.24 | $99.24 |