| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medcost
| Professional | $2,630.27 | $2,630.27 | $2,630.27 | |
United
| Facility | $1,819.70 | $10,232.93 | $18,197.01 | |
Wellcare
| Facility | $56.23 | $10,715.19 | $10,715.19 | |
Wellcare
| Facility | AS | $1,071.52 | $1,071.52 | $1,071.52 |