| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $350.00 | $350.00 | $350.00 | |
Aetna
| Professional | $350.00 | $350.00 | $350.00 | |
Cigna
| Facility | $497.75 | $497.75 | $497.75 | |
Lucent Health
| Facility | $100.00 | $514.79 | $514.79 |