| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $67.00 | $102.00 | $301.50 | |
Hally Health
| Facility | $150.00 | $150.00 | $150.00 | |
Medica
| Facility | $100.00 | $100.00 | $100.00 | |
Wellmark
| Facility | $45.25 | $18,170.00 | $40,290.00 |