| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $5.77 | $7.83 | $12.79 | |
Aetna
| Professional | $5.77 | $5.77 | $7.28 | |
Cigna
| Facility | $5.77 | $5.77 | $5.77 | |
Cigna
| Professional | $5.77 | $5.77 | $5.77 | |
Lucent Health
| Facility | $75.00 | $646.52 | $646.52 | |
United
| Facility | $10.41 | $10.41 | $10.41 | |
United
| Professional | $5.77 | $5.77 | $16.28 |