| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $16,775.59 | $20,300.70 | $25,002.00 | |
Hally Health
| Facility | $150.00 | $150.00 | $150.00 | |
Medica
| Facility | $16,020.02 | $20,710.84 | $32,453.62 | |
United
| Facility | $19,637.61 | $26,171.26 | $34,539.01 |