| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $239.88 | $239.88 | $239.88 | |
Aetna
| Professional | $239.88 | $239.88 | $354.81 | |
Hally Health
| Professional | $151.36 | $275.42 | $1,445.44 | |
Medica
| Facility | $239.88 | $251.19 | $416.87 |