| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $127.28 | $127.28 | $127.28 | |
Aetna
| Professional | $127.28 | $143.79 | $143.79 | |
Medica
| Facility | $139.86 | $143.79 | $214.52 | |
Medica
| Professional | $162.32 | $223.28 | $1,169.68 | |
United
| Professional | $161.68 | $223.28 | $442.75 |