| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $124.50 | $124.50 | $217.88 | |
Aetna
| Professional | $120.00 | $124.50 | $124.50 | |
Cigna
| Facility | $127.50 | $127.50 | $127.50 | |
Cigna
| Professional | $127.50 | $127.50 | $127.50 | |
Lucent Health
| Facility | $330.00 | $1,457.50 | $1,457.50 | |
United
| Professional | $125.00 | $125.00 | $127.50 |