| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,017.00 | $3,221.00 | $7,723.00 | |
Aetna
| Professional | $1,017.00 | $3,270.00 | $10,073.00 | |
Hally Health
| Professional | $100.00 | $200.00 | $345.40 | |
Hally Health
| Facility | $100.00 | $100.00 | $100.00 | |
United
| Facility | $165.00 | $900.00 | $3,686.00 |