| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $100.00 | $125.89 | $154.88 | |
Providence
| Facility | $87.10 | $151.36 | $257.04 | |
Providence
| Professional | $79.43 | $79.43 | $125.89 | |
United
| Professional | $125.89 | $125.89 | $125.89 |