| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $17.86 | $17.86 | $17.86 | |
Aetna
| Professional | $17.86 | $17.86 | $17.86 | |
Medica
| Facility | $17.86 | $21.01 | $28.58 | |
Medica
| Professional | $21.01 | $21.01 | $21.01 | |
United
| Professional | $21.01 | $21.01 | $21.86 |