| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $50.00 | $50.00 | $50.00 | |
Aetna
| Professional | $50.00 | $50.00 | $50.00 | |
Medica
| Facility | $50.00 | $82.50 | $95.00 | |
Medica
| Professional | $139.60 | $139.60 | $139.60 | |
United
| Professional | $68.73 | $68.73 | $84.10 |