| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $63.10 | $95.50 | $524.81 | |
Aetna
| Professional | $63.10 | $93.33 | $104.71 | |
Medica
| Facility | $63.10 | $107.15 | $190.55 | |
Medica
| Professional | $85.11 | $147.91 | $223.87 | |
United
| Professional | $85.11 | $112.20 | $186.21 |