| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $923.00 | $3,221.00 | $7,407.00 | |
Aetna
| Professional | $3,520.23 | $3,520.23 | $3,520.23 | |
Hally Health
| Professional | $100.00 | $345.40 | $345.40 | |
Hally Health
| Facility | $100.00 | $100.00 | $100.00 |