| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $186.21 | $186.21 | $186.21 | |
Aetna
| Professional | $67.61 | $173.78 | $218.78 | |
Hally Health
| Professional | $199.53 | $263.03 | $354.81 | |
Hally Health
| Facility | $100.00 | $100.00 | $100.00 | |
Molina
| Professional | $30.20 | $30.20 | $30.20 |