| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $23.68 | $23.68 | $23.68 | |
Aetna
| Professional | $8.00 | $23.68 | $23.68 | |
Cigna
| Facility | $120.00 | $120.00 | $147.90 | |
Cigna
| Professional | $70.50 | $75.72 | $75.72 | |
Lucent Health
| Facility | $80.00 | $109.00 | $109.00 |