| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $41.69 | $851.14 | $851.14 | |
Aetna
| Professional | $851.14 | $851.14 | $1,122.02 | |
Hally Health
| Professional | $151.36 | $1,071.52 | $1,071.52 | |
Medica
| Facility | $851.14 | $1,318.26 | $2,137.96 | |
United
| Facility | $1,122.02 | $1,949.84 | $2,570.40 |