| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1.00 | $1.00 | $1.00 | |
Aetna
| Professional | $1.00 | $1.00 | $21.88 | |
Medica
| Facility | $0.76 | $0.83 | $2.29 | |
Medica
| Professional | $54.95 | $66.07 | $109.65 | |
United
| Professional | $54.95 | $66.07 | $109.65 |