| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $4,277.00 | $6,066.00 | $11,100.08 | |
Hally Health
| Professional | $270.61 | $445.02 | $1,183.93 | |
Medica
| Facility | $398.57 | $661.93 | $4,663.00 | |
Medica
| Facility | AS | $133.22 | $133.22 | $133.22 |
Midlands
| Facility | $505.15 | $645.23 | $835.82 | |
United
| Facility | $2,126.00 | $5,847.00 | $7,856.00 |