| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $794.33 | $2,344.23 | $7,762.47 | |
Aetna
| Professional | $794.33 | $1,380.38 | $10,000.00 | |
Hally Health
| Professional | $120.23 | $199.53 | $346.74 | |
Hally Health
| Facility | $100.00 | $100.00 | $100.00 |