| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $363.08 | $363.08 | $363.08 | |
Aetna
| Professional | $41.69 | $363.08 | $602.56 | |
Cigna
| Professional | $102.33 | $107.15 | $128.82 | |
Hally Health
| Professional | $66.07 | $95.50 | $154.88 | |
United
| Professional | $41.69 | $54.95 | $93.33 |