| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $13,608.20 | $16,467.70 | $20,281.30 | |
Hally Health
| Facility | $150.00 | $150.00 | $150.00 | |
Medica
| Facility | $12,995.21 | $16,800.34 | $26,325.91 | |
United
| Facility | $15,929.75 | $21,229.75 | $28,017.56 |