| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $4,277.00 | $5,549.00 | $11,100.08 | |
Hally Health
| Professional | $150.00 | $150.00 | $150.00 | |
Medica
| Facility | $13,990.00 | $22,236.52 | $46,710.40 | |
United
| Facility | $12,855.00 | $16,742.00 | $21,923.00 |