| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $39.60 | $39.60 | $8,500.00 | |
Aetna
| Professional | $39.60 | $39.60 | $59.90 | |
Medica
| Facility | $39.60 | $39.60 | $118.80 | |
Medica
| Professional | $30.98 | $52.40 | $146.34 | |
United
| Professional | $34.06 | $59.55 | $146.34 |