| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $64.57 | $93.33 | $123.03 | |
Providence
| Facility | $114.82 | $181.97 | $309.03 | |
Providence
| Professional | $85.11 | $125.89 | $181.97 | |
United
| Professional | $125.89 | $125.89 | $125.89 |