| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $18.20 | $18.20 | $18.20 | |
Aetna
| Professional | $18.20 | $18.20 | $18.20 | |
Hally Health
| Professional | $100.00 | $199.53 | $346.74 | |
Hally Health
| Facility | $100.00 | $100.00 | $100.00 |