| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $10.00 | $10.00 | $10.00 | |
Aetna
| Professional | $10.00 | $10.00 | $10.00 | |
Medica
| Facility | $10.00 | $10.00 | $16.98 | |
Medica
| Professional | $28.84 | $28.84 | $28.84 | |
United
| Professional | $7.24 | $13.80 | $47.86 |