| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,398.00 | $2,398.00 | $2,398.00 | |
Aetna
| Professional | $2,398.00 | $2,398.00 | $4,916.51 | |
Hally Health
| Professional | $150.00 | $150.00 | $150.00 | |
Medica
| Facility | $2,398.00 | $2,398.00 | $8,255.20 |