| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $161.71 | $253.64 | $253.64 |
Cigna
| Facility | 26 | $178.90 | $178.90 | $178.90 |
Hally Health
| Professional | 26 | $156.37 | $223.38 | $1,289.94 |
Hally Health
| Facility | 26 | $100.00 | $100.00 | $100.00 |