| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,601.60 | $6,361.00 | $6,361.00 | |
Aetna
| Professional | $9.74 | $38.59 | $2,673.50 | |
Cigna
| Professional | $125.40 | $125.40 | $125.40 | |
Lucent Health
| Facility | $100.00 | $100.00 | $100.00 |