| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $173.00 | $173.00 | $173.00 | |
Aetna
| Professional | $173.00 | $173.00 | $173.00 | |
Cigna
| Facility | $247.50 | $263.02 | $263.02 | |
Cigna
| Professional | $192.01 | $192.01 | $263.02 | |
Lucent Health
| Facility | $100.00 | $161.19 | $161.19 | |
United
| Professional | $93.21 | $93.21 | $93.21 |