| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,445.44 | $2,344.23 | $8,128.31 | |
Medcost
| Facility | $1,445.44 | $1,949.84 | $2,951.21 | |
United
| Facility | $1,174.90 | $3,890.45 | $6,918.31 | |
Wellcare
| Facility | $56.23 | $20,417.38 | $20,417.38 | |
Wellcare
| Facility | AS | $2,041.74 | $2,041.74 | $2,041.74 |