| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $1,924.17 | $1,924.17 | $1,924.17 | |
Providence
| Facility | $763.75 | $763.75 | $775.45 | |
Providence
| Professional | $323.95 | $323.95 | $437.18 | |
United
| Professional | $568.36 | $655.60 | $765.10 |