| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $107.15 | $177.83 | $512.86 |
Cigna
| Facility | 26 | $131.83 | $131.83 | $131.83 |
Hally Health
| Professional | 26 | $109.65 | $154.88 | $776.25 |
Hally Health
| Facility | 26 | $100.00 | $100.00 | $100.00 |