| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $23.44 | $23.44 | $23.44 | |
Cigna
| Professional | $25.12 | $25.70 | $32.36 | |
Hally Health
| Professional | $18.62 | $26.30 | $199.53 | |
Hally Health
| Facility | $100.00 | $100.00 | $100.00 | |
United
| Facility | $33.11 | $33.11 | $33.11 |