| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $21.23 | $25.48 | $42.04 | |
Aetna
| Professional | $21.23 | $21.23 | $25.69 | |
Cigna
| Facility | $28.21 | $28.21 | $28.21 | |
Cigna
| Professional | $28.21 | $28.21 | $28.21 | |
Lucent Health
| Facility | $75.00 | $113.14 | $113.14 | |
United
| Professional | $21.23 | $21.23 | $28.21 |