| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $184.68 | $418.99 | $16,467.00 | |
Medcost
| Facility | $160.08 | $204.30 | $346.21 | |
Medcost
| Facility | 80 | $40.86 | $40.86 | $56.86 |
Medcost
| Facility | AS | $28.60 | $28.60 | $39.79 |
United
| Facility | $659.00 | $6,107.00 | $8,818.00 |