| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,475.76 | $2,084.77 | $7,439.00 | |
Medcost
| Facility | $1,475.76 | $2,041.03 | $3,481.12 | |
United
| Facility | $1,172.00 | $4,086.00 | $7,778.00 | |
Wellcare
| Facility | $55.00 | $22,253.76 | $26,817.76 |