| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,652.81 | $1,652.81 | $31,908.10 | |
Aetna
| Professional | $1,551.00 | $11,983.98 | $23,152.50 | |
Hally Health
| Professional | $120.00 | $200.00 | $345.40 | |
Hally Health
| Facility | $100.00 | $100.00 | $100.00 |