| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $4,277.00 | $6,066.00 | $11,100.08 | |
Aetna
| Professional | $47.86 | $47.86 | $47.86 | |
Hally Health
| Professional | $87.60 | $98.91 | $625.00 | |
Medica
| Facility | $47.86 | $1,607.00 | $2,338.00 | |
United
| Facility | $1,204.00 | $1,607.00 | $2,126.00 |