| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $7,961.62 | $7,961.62 | $7,961.62 | |
Aetna
| Professional | $7,124.68 | $7,961.62 | $9,378.75 | |
Hally Health
| Professional | $150.00 | $150.00 | $150.00 | |
Medica
| Facility | $5,913.52 | $7,961.62 | $13,534.75 |