| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $42.20 | $76.95 | $76.95 |
Cigna
| Facility | 26 | $46.26 | $46.26 | $46.26 |
Hally Health
| Professional | 26 | $40.18 | $57.41 | $1,056.92 |
Hally Health
| Facility | 26 | $100.00 | $100.00 | $100.00 |