| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $117.19 | $147.66 | $255.36 | |
Aetna
| Professional | $117.36 | $117.36 | $141.80 | |
Cigna
| Facility | $117.36 | $117.36 | $117.36 | |
Cigna
| Professional | $117.36 | $117.36 | $117.36 | |
Lucent Health
| Facility | $154.93 | $582.35 | $586.79 | |
United
| Professional | $116.41 | $117.36 | $117.36 |