| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $148.40 | $192.92 | $293.83 | |
Aetna
| Professional | $143.04 | $148.40 | $148.40 | |
Cigna
| Facility | $151.97 | $151.97 | $151.97 | |
Cigna
| Professional | $151.97 | $151.97 | $151.97 | |
Lucent Health
| Facility | $178.80 | $178.80 | $670.50 |