| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $234.42 | $616.60 | $616.60 | |
Aetna
| Professional | $138.04 | $190.55 | $295.12 | |
Providence
| Facility | $186.21 | $186.21 | $190.55 | |
United
| Professional | $165.96 | $186.21 | $302.00 |