| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $67.61 | $102.33 | $323.59 | |
Hally Health
| Facility | $151.36 | $151.36 | $151.36 | |
Medica
| Facility | $100.00 | $100.00 | $100.00 | |
Wellmark
| Facility | $18,197.01 | $28,183.83 | $40,738.03 |