| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $7,943.28 | $7,943.28 | $7,943.28 | |
Aetna
| Professional | $3,801.89 | $7,943.28 | $7,943.28 | |
Hally Health
| Professional | $151.36 | $151.36 | $151.36 | |
Medica
| Facility | $6,760.83 | $7,943.28 | $13,489.63 |