| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,106.83 | $2,602.73 | $16,467.00 | |
Medcost
| Facility | $922.67 | $1,272.52 | $2,079.19 | |
Medcost
| Facility | 80 | $198.20 | $255.26 | $353.23 |
United
| Facility | $659.00 | $6,107.00 | $8,818.00 |