| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $1,671.31 | $1,671.31 | $2,412.71 | |
Medcost
| Facility | $1,880.00 | $4,950.00 | $4,950.00 | |
Medcost
| Professional | $1,633.61 | $1,633.61 | $1,633.61 | |
United
| Professional | $1,256.63 | $1,507.95 | $4,021.20 | |
Wellcare
| Facility | $23,512.50 | $23,512.50 | $23,512.50 | |
Wellcare
| Professional | $24,651.00 | $24,651.00 | $37,125.00 |