| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $106.18 | $106.18 | $106.18 | |
Aetna
| Professional | $106.18 | $106.18 | $150.05 | |
Medica
| Facility | $106.18 | $180.51 | $318.54 | |
Medica
| Professional | $173.82 | $296.72 | $380.81 | |
United
| Professional | $178.26 | $293.81 | $380.81 |