| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,398.83 | $2,398.83 | $2,398.83 | |
Aetna
| Professional | $2,398.83 | $2,398.83 | $2,398.83 | |
Hally Health
| Professional | $151.36 | $151.36 | $151.36 | |
Medica
| Facility | $2,398.83 | $2,511.89 | $4,265.80 |