| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $193.00 | $319.54 | $7,439.00 | |
Medcost
| Facility | $193.00 | $279.99 | $483.99 | |
United
| Facility | $1,172.00 | $4,086.00 | $7,778.00 | |
Wellcare
| Facility | $55.00 | $474.41 | $1,300.00 |