| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $52.48 | $100.00 | $165.96 |
Cigna
| Facility | 26 | $72.44 | $72.44 | $72.44 |
Hally Health
| Professional | 26 | $66.07 | $104.71 | $630.96 |
Hally Health
| Facility | 26 | $100.00 | $100.00 | $100.00 |