| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $791.41 | $791.41 | $1,384.97 | |
Aetna
| Professional | $791.41 | $791.41 | $791.41 | |
Cigna
| Facility | $64.00 | $64.00 | $64.00 | |
Cigna
| Professional | $271.26 | $271.26 | $271.26 | |
Lucent Health
| Facility | $100.00 | $100.00 | $100.00 |