| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,132.86 | $2,545.84 | $16,467.00 | |
Medcost
| Facility | $929.52 | $1,246.16 | $2,102.42 | |
Medcost
| Facility | AS | $166.46 | $172.39 | $251.96 |
United
| Facility | $3,340.00 | $21,721.00 | $33,299.00 |