| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $253.28 | $501.87 | $16,467.00 | |
Medcost
| Facility | $182.38 | $253.28 | $442.52 | |
Medcost
| Facility | 80 | $44.00 | $52.40 | $89.21 |
Medcost
| Facility | AS | $30.38 | $35.04 | $62.45 |
United
| Facility | $659.00 | $6,107.00 | $8,818.00 |