| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $33.21 | $33.21 | $33.21 | |
Aetna
| Professional | $33.21 | $33.21 | $33.21 | |
Medica
| Facility | $33.21 | $34.86 | $144.50 | |
Medica
| Professional | $23.07 | $26.71 | $29.14 | |
United
| Professional | $23.07 | $26.71 | $29.14 |