| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $16.78 | $16.78 | $33.39 | |
Aetna
| Professional | $16.78 | $16.78 | $16.78 | |
Medica
| Facility | $16.78 | $18.46 | $24.00 | |
Medica
| Professional | $20.72 | $20.72 | $20.72 | |
United
| Professional | $20.72 | $20.72 | $20.72 |