| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $6.03 | $6.03 | $6.03 | |
Aetna
| Professional | $6.03 | $6.03 | $6.03 | |
Medica
| Facility | $6.03 | $6.03 | $10.23 | |
Medica
| Professional | $16.22 | $16.22 | $16.22 | |
United
| Professional | $9.55 | $9.55 | $9.55 |