| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $45.76 | $45.76 | $80.08 | |
Aetna
| Professional | $45.76 | $45.76 | $45.76 | |
Lucent Health
| Facility | $100.00 | $100.00 | $100.00 | |
Lucent Health
| Professional | $54.40 | $54.40 | $54.40 |