| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,218.00 | $3,576.15 | $7,119.04 | |
Hally Health
| Professional | $302.16 | $479.21 | $796.16 | |
Medica
| Facility | $385.53 | $749.11 | $7,123.00 | |
Medica
| Facility | 62 | $889.38 | $889.38 | $889.38 |
Medica
| Facility | AS | $142.30 | $142.30 | $142.30 |
Midlands
| Facility | $577.03 | $723.76 | $983.41 | |
United
| Facility | $2,126.00 | $5,847.00 | $7,305.00 |