| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $794.33 | $794.33 | $1,000.00 | |
Hally Health
| Professional | $151.36 | $151.36 | $812.83 | |
Medica
| Facility | $616.60 | $616.60 | $3,630.78 | |
Medica
| Professional | $489.78 | $707.95 | $1,659.59 |