| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $6.63 | $6.63 | $6.63 | |
Aetna
| Professional | $4.79 | $6.63 | $8.65 | |
Medica
| Facility | $6.63 | $6.96 | $70.00 | |
Medica
| Professional | $7.68 | $9.02 | $54.23 | |
United
| Professional | $7.68 | $9.02 | $14.39 |