| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $165.07 | $165.07 | $264.48 | |
Aetna
| Professional | $101.39 | $165.07 | $211.36 | |
Medica
| Facility | $165.07 | $181.58 | $4,042.45 | |
Medica
| Professional | $175.54 | $213.48 | $430.72 | |
United
| Professional | $164.76 | $197.51 | $329.13 |