| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $240.00 | $240.00 | $240.00 | |
Aetna
| Professional | $240.00 | $240.00 | $571.50 | |
Medica
| Facility | $240.00 | $240.00 | $720.00 | |
Medica
| Professional | $253.40 | $475.82 | $660.54 | |
United
| Professional | $263.41 | $506.80 | $627.66 |