| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $102.32 | $2,145.78 | $7,838.38 | |
Providence
| Facility | $108.72 | $153.69 | $210.19 | |
Providence
| Facility | AS | $34.29 | $34.29 | $34.29 |
United
| Facility | $230.00 | $1,158.00 | $1,401.00 |