| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $123.27 | $123.27 | $123.27 | |
Aetna
| Professional | $123.27 | $123.27 | $123.27 | |
Medica
| Facility | $110.02 | $123.27 | $714.54 | |
Medica
| Professional | $134.19 | $185.93 | $1,169.68 | |
United
| Professional | $129.34 | $177.61 | $259.39 |