| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $5.00 | $5.00 | $5.00 | |
Aetna
| Professional | $5.00 | $5.00 | $5.00 | |
Medica
| Facility | $5.00 | $5.00 | $8.44 | |
Medica
| Professional | $31.11 | $31.11 | $31.11 | |
United
| Professional | $7.51 | $7.51 | $25.99 |