| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $116.00 | $116.00 | $123.25 | |
Hally Health
| Professional | $150.00 | $200.00 | $755.00 | |
Medica
| Facility | $116.00 | $139.19 | $210.25 | |
Medica
| Professional | $319.00 | $319.00 | $319.00 |