| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $20.00 | $20.00 | $20.00 | |
Aetna
| Professional | $20.00 | $20.00 | $128.86 | |
Medica
| Facility | $20.00 | $33.00 | $40.00 | |
Medica
| Professional | $515.64 | $515.64 | $515.64 | |
Midlands
| Professional | $243.21 | $252.33 | $252.33 |