| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $254.20 | $537.52 | $16,467.00 | |
Medcost
| Facility | $193.16 | $267.13 | $443.14 | |
Medcost
| Facility | AS | $29.26 | $37.40 | $51.06 |
United
| Facility | $659.00 | $6,107.00 | $8,818.00 |