| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $54.95 | $58.88 | $66.07 | |
Aetna
| Professional | $39.81 | $61.66 | $75.86 | |
Medica
| Facility | $39.81 | $58.88 | $100.00 | |
Medica
| Professional | $58.88 | $74.13 | $331.13 | |
United
| Professional | $54.95 | $69.18 | $102.33 |