| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $921.48 | $2,200.21 | $16,467.00 | |
Medcost
| Facility | $765.02 | $1,046.33 | $1,785.19 | |
Medcost
| Facility | 50 | $1,269.00 | $1,576.98 | $2,239.50 |
United
| Facility | $659.00 | $6,107.00 | $8,818.00 |