| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $79.52 | $126.02 | $126.02 |
Cigna
| Facility | 26 | $88.38 | $88.38 | $88.38 |
Hally Health
| Professional | 26 | $78.22 | $116.13 | $2,021.30 |
Hally Health
| Facility | 26 | $100.00 | $100.00 | $100.00 |