| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $41.50 | $41.50 | $41.50 | |
Aetna
| Professional | $41.50 | $42.53 | $42.53 | |
Medica
| Facility | $43.40 | $68.43 | $84.74 | |
Medica
| Professional | $48.55 | $80.59 | $262.88 | |
Midlands
| Facility | $49.74 | $54.85 | $80.42 | |
Midlands
| Professional | $54.85 | $54.85 | $80.42 | |
United
| Professional | $41.73 | $64.56 | $86.70 |