| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $114.82 | $199.53 | $8,128.31 | |
Aetna
| Professional | $114.82 | $120.23 | $123.03 | |
Hally Health
| Professional | $120.23 | $169.82 | $346.74 | |
Hally Health
| Facility | $100.00 | $100.00 | $100.00 |