| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $17.88 | $17.88 | $17.88 | |
Medcost
| Facility | $1.94 | $1.94 | $1.94 | |
Medcost
| Professional | $1.94 | $1.94 | $1.94 | |
United
| Professional | $0.16 | $0.27 | $0.35 | |
Wellcare
| Facility | $85.00 | $95.00 | $100.00 |