| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $102.23 | $104.69 | $104.69 | |
Hally Health
| Professional | $150.00 | $150.00 | $275.00 | |
Medica
| Facility | $104.69 | $125.63 | $178.60 | |
Medica
| Professional | $270.97 | $270.97 | $270.97 |