| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $146.54 | $190.50 | $290.14 | |
Aetna
| Professional | $141.24 | $146.54 | $146.54 | |
Lucent Health
| Facility | $169.49 | $169.49 | $169.49 | |
United
| Professional | $136.80 | $136.80 | $150.07 |