| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $15,466.40 | $18,716.30 | $23,050.70 | |
Hally Health
| Facility | $150.00 | $150.00 | $150.00 | |
Medica
| Facility | $14,769.70 | $19,094.43 | $29,920.71 | |
United
| Facility | $18,104.95 | $24,128.67 | $31,843.35 |