| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $23.17 | $23.17 | $23.17 | |
Aetna
| Professional | $3.13 | $23.17 | $23.17 | |
Cigna
| Facility | $99.00 | $99.00 | $111.18 | |
Cigna
| Professional | $16.39 | $16.39 | $88.13 | |
Lucent Health
| Facility | $64.00 | $80.00 | $100.00 |