| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $3,768.95 | $3,768.95 | $3,768.95 | |
Aetna
| Professional | $3,768.95 | $3,768.95 | $3,768.95 | |
Lucent Health
| Facility | $64.00 | $100.00 | $2,667.60 | |
Lucent Health
| Professional | $2,371.19 | $2,371.19 | $2,371.19 |