| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $68.70 | $68.70 | $92.60 | |
Aetna
| Professional | $67.09 | $68.70 | $80.52 | |
Medcost
| Facility | $68.70 | $72.83 | $89.10 | |
Medcost
| Professional | $76.80 | $76.80 | $76.80 | |
United
| Professional | $80.84 | $80.84 | $105.09 | |
Wellcare
| Facility | $100.00 | $100.00 | $100.00 |