| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $19.95 | $19.95 | $19.95 | |
Aetna
| Professional | $19.95 | $25.12 | $64.57 | |
Medica
| Facility | $20.42 | $26.92 | $45.71 | |
Medica
| Professional | $158.49 | $158.49 | $158.49 | |
United
| Professional | $44.67 | $57.54 | $85.11 |