| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $25.87 | $25.87 | $25.87 | |
Aetna
| Professional | $8.00 | $25.87 | $136.00 | |
Cigna
| Facility | $120.00 | $120.00 | $146.88 | |
Cigna
| Professional | $18.77 | $18.77 | $87.66 | |
Lucent Health
| Facility | $80.00 | $108.27 | $108.27 |