| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $82.90 | $131.10 | $131.10 |
Cigna
| Facility | 26 | $92.58 | $92.58 | $92.58 |
Hally Health
| Professional | 26 | $80.54 | $114.48 | $2,796.28 |
Hally Health
| Facility | 26 | $100.00 | $100.00 | $100.00 |