| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $184.38 | $184.38 | $322.67 | |
Aetna
| Professional | $184.38 | $184.38 | $184.38 | |
Lucent Health
| Facility | $100.00 | $100.00 | $100.00 | |
Lucent Health
| Professional | $87.73 | $87.73 | $87.73 |