| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $235.03 | $7,799.00 | $21,886.00 | |
Medcost
| Facility | $173.15 | $235.03 | $376.77 | |
Medcost
| Facility | AS | $27.04 | $31.48 | $43.63 |
United
| Facility | $659.00 | $6,107.00 | $8,818.00 |