| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $426.58 | $426.58 | $426.58 | |
Aetna
| Professional | $251.19 | $426.58 | $426.58 | |
Hally Health
| Professional | $151.36 | $204.17 | $204.17 | |
Medica
| Facility | $245.47 | $537.03 | $741.31 | |
United
| Facility | $316.23 | $549.54 | $741.31 |