| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,092.77 | $2,467.46 | $16,467.00 | |
Medcost
| Facility | $900.25 | $1,202.05 | $2,036.82 | |
Medcost
| Facility | AS | $153.02 | $167.53 | $261.38 |
United
| Facility | $659.00 | $6,107.00 | $8,818.00 |