| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $104.69 | $104.69 | $183.21 | |
Aetna
| Professional | $102.23 | $104.69 | $104.69 | |
Lucent Health
| Facility | $105.93 | $178.60 | $178.60 | |
Lucent Health
| Professional | $270.97 | $270.97 | $270.97 |