| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $342.30 | $342.30 | $342.30 | |
Aetna
| Professional | $342.30 | $342.30 | $408.02 | |
Hally Health
| Professional | $304.33 | $428.83 | $926.16 | |
Hally Health
| Facility | $100.00 | $100.00 | $100.00 | |
Hally Health
| Professional | $359.66 | $365.16 | $398.20 |