| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $3.02 | $3.02 | $3.02 | |
Aetna
| Professional | $3.02 | $3.02 | $3.02 | |
Cigna
| Professional | $8.51 | $8.51 | $8.51 | |
Hally Health
| Professional | $120.23 | $169.82 | $346.74 | |
Hally Health
| Facility | $100.00 | $100.00 | $100.00 | |
United
| Professional | $44.67 | $44.67 | $47.86 |