| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $4,277.00 | $5,549.00 | $11,100.08 | |
Hally Health
| Professional | $261.98 | $508.74 | $1,257.60 | |
Medica
| Facility | $494.64 | $659.88 | $5,847.00 | |
Medica
| Facility | AS | $133.24 | $133.24 | $133.24 |
Midlands
| Facility | $407.67 | $620.82 | $782.61 | |
United
| Facility | $2,126.00 | $5,847.00 | $7,305.00 |