| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $177.55 | $9,062.00 | $47,158.85 | |
Medcost
| Facility | $134.91 | $177.55 | $306.17 | |
Medcost
| Facility | 80 | $33.00 | $33.75 | $51.70 |
Medcost
| Facility | AS | $20.44 | $23.63 | $33.06 |
United
| Facility | $659.00 | $6,107.00 | $8,818.00 |