| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $50.00 | $50.00 | $87.50 | |
Aetna
| Professional | $50.00 | $50.00 | $50.00 | |
Lucent Health
| Facility | $100.00 | $100.00 | $187.52 | |
Lucent Health
| Professional | $139.60 | $139.60 | $139.60 |