| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $104.71 | $131.83 | $131.83 | |
Hally Health
| Professional | $151.36 | $151.36 | $151.36 | |
Medica
| Facility | $138.04 | $138.04 | $138.04 | |
Medica
| Professional | $281.84 | $281.84 | $281.84 |