| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $157.05 | $239.37 | $418.90 | |
Aetna
| Professional | $239.37 | $239.37 | $659.93 | |
Lucent Health
| Facility | $100.00 | $100.00 | $100.00 | |
Lucent Health
| Professional | $448.80 | $448.80 | $448.80 |