| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $35.79 | $35.79 | $35.79 | |
Aetna
| Professional | $35.79 | $35.79 | $54.21 | |
Medica
| Facility | $35.79 | $60.86 | $107.40 | |
Medica
| Professional | $58.15 | $99.26 | $127.34 | |
United
| Professional | $58.15 | $97.27 | $119.66 |