| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $112.20 | $125.89 | $144.54 | |
Providence
| Facility | $114.82 | $181.97 | $309.03 | |
Providence
| Professional | $85.11 | $125.89 | $181.97 | |
United
| Professional | $125.89 | $125.89 | $125.89 |