| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $57.54 | $57.54 | $57.54 | |
Aetna
| Professional | $57.54 | $57.54 | $100.00 | |
Medica
| Facility | $58.88 | $61.66 | $100.00 | |
Medica
| Professional | $177.83 | $177.83 | $177.83 | |
United
| Facility | $109.65 | $109.65 | $117.49 | |
United
| Professional | $9.77 | $9.77 | $9.77 |