| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $89.22 | $100.78 | $130.60 | |
Medica
| Facility | $89.22 | $123.28 | $173.82 | |
Medica
| Professional | $121.62 | $245.00 | $778.48 | |
United
| Professional | $121.62 | $237.86 | $337.24 |