| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $436.82 | $4,375.00 | $16,467.00 | |
Medcost
| Facility | $331.93 | $438.00 | $716.67 | |
Medcost
| Facility | 80 | $84.40 | $85.46 | $129.02 |
Medcost
| Facility | AS | $50.21 | $59.82 | $82.62 |
United
| Facility | $659.00 | $6,107.00 | $8,818.00 |