| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $51.74 | $51.74 | $51.74 | |
Aetna
| Professional | $51.74 | $51.74 | $70.09 | |
Medica
| Facility | $51.74 | $56.91 | $129.02 | |
Medica
| Professional | $53.31 | $72.34 | $130.13 | |
United
| Professional | $60.92 | $72.34 | $95.93 |