| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $63.28 | $63.28 | $69.29 | |
Aetna
| Professional | $63.28 | $69.29 | $69.29 | |
Lucent Health
| Facility | $100.00 | $100.00 | $100.00 | |
Lucent Health
| Professional | $272.97 | $272.97 | $272.97 |