| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $755.21 | $755.21 | $755.21 | |
Aetna
| Professional | $755.21 | $755.21 | $900.21 | |
Hally Health
| Professional | $294.39 | $414.97 | $1,395.89 | |
Hally Health
| Facility | $100.00 | $100.00 | $100.00 | |
Hally Health
| Professional | $347.93 | $352.98 | $385.33 |