| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $187.62 | $300.30 | $300.30 |
Cigna
| Facility | 26 | $194.40 | $194.40 | $194.40 |
Hally Health
| Professional | 26 | $173.32 | $258.69 | $1,574.16 |
Hally Health
| Facility | 26 | $100.00 | $100.00 | $100.00 |