| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $206.71 | $411.48 | $5,449.00 | |
Medcost
| Facility | $206.71 | $365.95 | $561.79 | |
United
| Facility | $2,526.00 | $7,659.00 | $10,502.00 | |
Wellcare
| Facility | $1,062.85 | $1,062.85 | $12,000.00 |