| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $0.80 | $0.80 | $0.80 | |
Aetna
| Professional | $0.80 | $0.80 | $14.46 | |
Medica
| Facility | $0.80 | $2.39 | $90.00 | |
Medica
| Professional | $38.04 | $38.04 | $38.04 | |
United
| Professional | $38.04 | $38.04 | $38.04 |