| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $22.51 | $22.51 | $22.51 | |
Aetna
| Professional | $9.00 | $22.51 | $22.51 | |
Cigna
| Facility | $77.00 | $77.00 | $102.00 | |
Cigna
| Professional | $20.89 | $20.89 | $153.75 | |
Lucent Health
| Facility | $120.00 | $120.00 | $120.00 |