| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $64.80 | $64.80 | $64.80 | |
Aetna
| Professional | $64.80 | $64.80 | $64.80 | |
Cigna
| Professional | $27.79 | $27.79 | $27.79 | |
Lucent Health
| Facility | $100.00 | $100.00 | $100.00 | |
Lucent Health
| Professional | $272.97 | $272.97 | $272.97 |