| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $26.00 | $26.00 | $26.00 | |
Aetna
| Professional | $26.00 | $26.00 | $65.00 | |
Medica
| Facility | $26.00 | $43.94 | $50.70 | |
Medica
| Professional | $0.85 | $0.85 | $0.85 | |
Midlands
| Facility | $0.85 | $0.85 | $0.85 | |
Midlands
| Professional | $0.85 | $0.85 | $0.85 |