| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $80.17 | $124.99 | $124.99 |
Cigna
| Facility | 26 | $88.74 | $88.74 | $88.74 |
Hally Health
| Professional | 26 | $78.72 | $117.31 | $2,018.99 |
Hally Health
| Facility | 26 | $100.00 | $100.00 | $100.00 |