| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $129.72 | $142.69 | $194.58 | |
Aetna
| Professional | $129.72 | $129.72 | $129.72 | |
Medica
| Facility | $129.72 | $136.21 | $5,622.32 | |
Medica
| Professional | $150.08 | $200.76 | $6,299.47 | |
United
| Professional | $147.78 | $181.14 | $302.25 |