| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $10,294.60 | $12,457.80 | $15,342.80 | |
Hally Health
| Facility | $150.00 | $150.00 | $150.00 | |
Medica
| Facility | $9,830.86 | $12,709.44 | $19,915.53 | |
United
| Facility | $12,050.84 | $16,060.29 | $21,195.25 |