| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $28.28 | $28.28 | $28.28 | |
Aetna
| Professional | $28.28 | $28.28 | $39.90 | |
Medica
| Facility | $28.28 | $48.08 | $84.84 | |
Medica
| Professional | $46.27 | $78.98 | $101.45 | |
United
| Professional | $46.27 | $84.12 | $97.45 |