| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $349.92 | $697.54 | $16,467.00 | |
Medcost
| Facility | $266.13 | $401.12 | $924.77 | |
Medcost
| Facility | AS | $40.29 | $58.94 | $189.00 |
United
| Facility | $4,252.00 | $26,459.00 | $63,302.00 |