| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $5,012.00 | $6,298.62 | $10,255.42 | |
Aetna
| Professional | $7,002.00 | $7,002.00 | $7,002.00 | |
Hally Health
| Professional | $150.00 | $150.00 | $150.00 | |
Medica
| Facility | $2,126.00 | $5,244.00 | $7,856.00 | |
United
| Facility | $2,126.00 | $5,847.00 | $7,856.00 |