| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $16.13 | $112.59 | $416.33 | |
Aetna
| Professional | $234.30 | $234.30 | $234.30 | |
Medcost
| Facility | $7.20 | $7.20 | $7.20 | |
Medcost
| Professional | $7.20 | $7.20 | $7.20 | |
Wellcare
| Facility | $100.00 | $100.00 | $1,245.88 |