| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $5,989.68 | $5,989.68 | $5,989.68 | |
Aetna
| Professional | $61.89 | $61.89 | $61.89 | |
Cigna
| Professional | $3.20 | $3.20 | $3.20 | |
Lucent Health
| Facility | $100.00 | $100.00 | $100.00 |