| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $119.70 | $119.70 | $119.70 | |
Aetna
| Professional | $119.70 | $119.70 | $119.70 | |
Cigna
| Facility | $94.50 | $94.50 | $94.50 | |
Cigna
| Professional | $80.33 | $94.50 | $150.55 | |
Lucent Health
| Facility | $64.00 | $106.04 | $134.96 |