| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $58.48 | $64.33 | $87.72 | |
Aetna
| Professional | $58.48 | $58.48 | $58.48 | |
Medica
| Facility | $58.48 | $61.40 | $2,489.36 | |
Medica
| Professional | $67.81 | $88.09 | $463.54 | |
United
| Professional | $66.26 | $80.81 | $133.29 |