| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,615.00 | $2,989.70 | $6,953.60 | |
Medcost
| Facility | $2,989.70 | $3,855.00 | $7,871.32 | |
United
| Facility | $1,172.00 | $4,086.00 | $7,778.00 | |
Wellcare
| Facility | $55.00 | $33,379.80 | $40,902.72 |