| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $467.74 | $467.74 | $467.74 | |
Aetna
| Professional | $85.11 | $416.87 | $562.34 | |
Hally Health
| Professional | $199.53 | $537.03 | $691.83 | |
Hally Health
| Facility | $100.00 | $100.00 | $100.00 | |
Molina
| Professional | $39.81 | $39.81 | $39.81 |