| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $325.62 | $743.76 | $16,467.00 | |
Medcost
| Facility | $272.29 | $407.03 | $638.73 | |
Medcost
| Facility | AS | $44.19 | $58.10 | $82.77 |
United
| Facility | $659.00 | $6,107.00 | $8,818.00 |