| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $120.35 | $120.35 | $366.27 | |
Aetna
| Professional | $116.00 | $120.35 | $123.25 | |
Lucent Health
| Facility | $124.70 | $210.25 | $210.25 | |
Lucent Health
| Professional | $319.00 | $319.00 | $319.00 |