| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $21.85 | $43.43 | $16,467.00 | |
Medcost
| Facility | $16.26 | $25.13 | $37.95 | |
Medcost
| Facility | 80 | $4.22 | $5.40 | $6.46 |
Medcost
| Facility | AS | $2.94 | $3.78 | $4.51 |
United
| Facility | $225.00 | $1,221.00 | $3,585.00 |