| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $275.70 | $275.70 | $275.70 | |
Aetna
| Professional | $275.70 | $275.70 | $301.62 | |
Cigna
| Facility | $226.63 | $226.63 | $226.63 | |
Cigna
| Professional | $192.64 | $192.64 | $226.63 | |
Lucent Health
| Facility | $80.00 | $90.00 | $90.00 |