| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $440.81 | $440.81 | $440.81 | |
Aetna
| Professional | $440.81 | $440.81 | $525.45 | |
Hally Health
| Professional | $269.94 | $380.37 | $1,005.07 | |
Hally Health
| Facility | $100.00 | $100.00 | $100.00 | |
Hally Health
| Professional | $319.02 | $323.87 | $353.18 |