| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $28.83 | $28.83 | $28.83 |
Cigna
| Facility | 26 | $62.37 | $64.23 | $66.11 |
Hally Health
| Professional | 26 | $21.66 | $32.39 | $154.25 |
Medica
| Facility | 26 | $64.23 | $64.23 | $64.23 |
Midlands
| Facility | 26 | $64.23 | $66.11 | $116.94 |