| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $44.67 | $44.67 | $79.43 | |
Aetna
| Professional | $44.67 | $44.67 | $44.67 | |
Cigna
| Facility | $380.19 | $380.19 | $380.19 | |
Cigna
| Professional | $275.42 | $275.42 | $275.42 | |
Lucent Health
| Facility | $64.57 | $100.00 | $100.00 |