| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $128.82 | $128.82 | $128.82 | |
Cigna
| Facility | $389.05 | $389.05 | $389.05 | |
Hally Health
| Professional | $100.00 | $199.53 | $346.74 | |
Hally Health
| Facility | $100.00 | $100.00 | $100.00 | |
Molina
| Professional | $33.11 | $33.11 | $33.11 |