| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,330.77 | $2,978.36 | $16,467.00 | |
Medcost
| Facility | $1,109.15 | $1,481.44 | $2,535.82 | |
Medcost
| Facility | AS | $186.24 | $203.14 | $320.87 |
United
| Facility | $659.00 | $6,107.00 | $8,818.00 |