| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $1,348.20 | $1,680.00 | $1,960.00 |
Lucent Health
| Facility | QK | $37.00 | $37.00 | $39.50 |
Lucent Health
| Facility | QX | $37.00 | $37.00 | $39.50 |
Providence
| Facility | QK | $162.80 | $162.80 | $162.80 |
Providence
| Facility | QX | $162.80 | $162.80 | $162.80 |