| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $172.21 | $172.21 | $342.70 | |
Aetna
| Professional | $172.21 | $172.21 | $172.21 | |
Medica
| Facility | $170.09 | $180.82 | $212.61 | |
Medica
| Professional | $180.30 | $180.30 | $180.30 | |
United
| Professional | $180.30 | $180.30 | $180.30 |