| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $18,902.00 | $22,874.00 | $28,171.20 | |
Hally Health
| Facility | $150.00 | $150.00 | $150.00 | |
Medica
| Facility | $18,050.63 | $23,336.05 | $36,567.28 | |
United
| Facility | $22,126.77 | $29,488.60 | $38,917.01 |