| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $68.02 | $87.08 | $157.29 | |
Aetna
| Professional | $68.02 | $85.92 | $110.71 | |
Aetna
| Professional | 25 | $20.57 | $100.86 | $101.95 |
Cigna
| Professional | $115.65 | $131.12 | $153.63 | |
Lucent Health
| Facility | $230.79 | $535.79 | $535.79 | |
United
| Professional | $82.74 | $99.24 | $205.63 |