| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $84.50 | $84.50 | $172.25 | |
Hally Health
| Professional | $14.82 | $20.01 | $35.57 | |
Hally Health
| Facility | $100.00 | $100.00 | $100.00 | |
Hally Health
| Professional | $17.51 | $17.64 | $19.27 |