| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,398.83 | $3,890.45 | $9,332.54 | |
Medcost
| Facility | $2,398.83 | $3,388.44 | $6,025.60 | |
United
| Facility | $1,174.90 | $3,890.45 | $6,918.31 | |
Wellcare
| Facility | $56.23 | $51,286.14 | $51,286.14 |