| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $13,427.40 | $16,249.00 | $20,012.00 | |
Hally Health
| Facility | $150.00 | $150.00 | $150.00 | |
Medica
| Facility | $12,822.62 | $16,577.22 | $25,976.29 | |
United
| Facility | $15,718.19 | $20,947.81 | $27,645.47 |