| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $133.05 | $177.41 | $340.57 | |
Aetna
| Facility | 25 | $286.80 | $286.80 | $286.80 |
BCBS
| Facility | $396.06 | $830.11 | $3,051.23 | |
Hally Health
| Professional | $219.19 | $306.08 | $683.87 | |
Hally Health
| Facility | $100.00 | $100.00 | $100.00 |