| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $204.17 | $204.17 | $204.17 | |
Aetna
| Professional | $204.17 | $204.17 | $204.17 | |
Hally Health
| Professional | $151.36 | $151.36 | $151.36 | |
Medica
| Facility | $316.23 | $346.74 | $371.54 |