| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $10.59 | $10.59 | $10.59 | |
Aetna
| Professional | $8.00 | $10.59 | $10.59 | |
Cigna
| Facility | $40.00 | $40.00 | $54.06 | |
Cigna
| Professional | $4.83 | $4.83 | $36.56 | |
Lucent Health
| Facility | $80.00 | $90.00 | $90.00 |