| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $65.48 | $65.48 | $130.31 | |
Aetna
| Professional | $65.48 | $65.48 | $65.48 | |
Medica
| Facility | $65.48 | $67.50 | $93.64 | |
Medica
| Professional | $80.84 | $80.84 | $80.84 | |
United
| Professional | $80.84 | $80.84 | $80.84 |