| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $201.98 | $201.98 | $201.98 | |
Aetna
| Professional | $176.47 | $176.47 | $201.98 | |
Providence
| Facility | $164.88 | $178.91 | $224.26 | |
United
| Professional | $180.30 | $180.30 | $180.30 |