| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $29.35 | $29.35 | $29.35 | |
Aetna
| Professional | $29.35 | $29.35 | $78.80 | |
Medica
| Facility | $29.35 | $29.35 | $88.05 | |
Medica
| Professional | $47.66 | $81.36 | $104.37 | |
United
| Professional | $48.94 | $86.66 | $104.61 |